HomeMy WebLinkAboutMIS93-00048 Cancelled Foundation - MIS Permit / Conditions - 3/25/1993 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
M 3E S C E L L A N E O U S P E R M I T FOR INSPECTIONS CALL 427-9670
MIS93-0048 PARCEL : 223047690202 PLAT: DIV: ? BLK : ? LOT : ?
JOB ADDRESS : NE 6951 TAHUYA—BLACKSMITH RD TAHUYA
APPLICANT: DAVID BROOKS
OWNER : DAVID B BROOKS
LEGAL : Tr 8-8 of Survey 12168
PROJECT DESCRIPTION :
foundation only— under mobile
PROJECT LOCATION :
GO OUT OLD DEWATTO RD PAST PANTHER LAKE UNTIL THE PAYMENT FINDS TURN RIGHT ON TAHUA BLACKSMITH
ROAD GO ABOUT 1 MILE TAKE 1ST FORK TO THE LEFT 2ND DRIVEWAY ON THE RIGHT HAND SIDE 8—B PARCEL .
PROJECT NOTES :
TYPE AMOUNT BY DATE RECEIPT
PRMT $ 15 . 00 TW 03/04 /93 32201
STFE $ 4 . 50 TW 03/04 /93 32201
TOTAL : 19 . 50 OWNER OR GEN DATE
MIS_PRMT, rev: 14(91/92 COMPLIANCE TO ATTACHED CONDITIONS IS
REQUIRED
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Case No . : MIS93-0048
For ; DAVID 8 BROOKS
Page : 1
l ) This is an AT YOUR OWN RISK permit. Owner /Contractor assumes all
liability /responsibility . All construction must meet or exceed local codes . Any
construction in violation of Mason County Rnqulotione will be removed at owners expense .
Do not pour prior to approval from the Mason County Building Department Inspector .
^
Permit No.BLD
couNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT
j
#1 Owner G�� ►/1 (� Rrx,K Phone#-- o?GG — 7�, - a( 2-
Site Address fl)F _LRSI TRFFckI�} - (3LAcKSrn i (Z�
City --u
St WCAS zip- z &8
Directions t Job Site o
o cwa as tak
if
ow'Tt _
lo C-c Owner Mailing Address c
City Sc�c �fiLc St_ LJc, _
Lien/Title Holder - Zip_
Address RAwc rr W
n/� � .
City n�KC.MP�Tnn ) St Lo-,
Zip
#2 Contractor Name
Contractor Reg#
` Address Expiration date
City St Zip Phone
#3 If septic is located on project site, include records . ifawu,o,r
Connect to Septic? Public Water Supply Well t`'«C- y
(If residential, proof of potable water may be required)
#4 Parcel No.
Legal Description 1,75G(-ry s - �(t(r, wc:' 4S7J-)J
r� (q 3y �v+ Fk
#5 Building Square Footage:
�SC�/ (existing/proposed)
1st Fl
2nd Fl_ / 3rd Fl_ / Loft- /
Basement_ / Deck- / #bedrooms
Garage- / Carport / --L- #bathrooms_
(Circle: Attached or Detached?)
i
Other sq ft_ /
#6 Use of building
Describe work
7 Type of Job: New Add Alt Repair Demolition
Woodstove Re-Roof Bulkhead Other
MOBILE HOME N RMATION
Model Ye Make�LecT Model I<G vt- ��d �,277s-?
Lengt 6 ' Width Serial No. FL -06
#Bedro �,� #Bathroo
-� Type of Heat 1 <<erp,c
Any water on or adjacent
O� �y(saltwater lake
river pond_other wetland seasonal—runoff—
Show following on the site plan I
Loth Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELOW
70. 70
N�
o A �v
z �
a► �J Y
ti
N
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
1
F�U� LeucL
PI,mmbing Fixtures ($3 each) Fee Fee 1
No. Toilets Vent Systems X 6.00 �—
Bath Basins 00
Vent Fans X 6. 00
Bath Tubs No. Boilers/Compressors
Showers HPy . 00
Hot Water Htr
Laundry Washer
-2 Sinks No. Air Handling Unit
Floor Drains cfm.
Laundry Basins
Dishwasher No. Fire Protection Systems
Disposal �u�LT �J Srnn�CC �eTCcTorS
Urinals
Other
Permit Basic Fee 15 . 00 No. Other
TOTAL PLUMBING $ 0;0
GG s Outlets X 6 . 00
VWoodstove, Pellet 25 . 00
Mechanical Fixtures Other
No. Fuel Types
Furn BTU .00 Permit Basic Fee 15 .00
TOTAL MECHANICAL $
Heat Pumps . 00
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
�I
I
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK -DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVA FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE 7-/ -c/ DATE
#�
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
..;:..;:.::
... ....
#9
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved coed Hold '
Approval
Planning:
v
Environmental Health:
- MT
Building Plan Review:
3 3i i'3
Occupancy Group: 3 ), L
Fire Marshal:
Other:
------------
" 0
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FEES
))Special Conditions: II IISite Inspection
II II I
)) II IlBuilding Permit o I
) II
Ilviolation Fee
f II llviolation Investigation Fee I II
II I
II IlPlan Check I ))
II Plumbing Fee I II
II
11 ))Mechanical Fee
11
I
II IlWoodstove Fee
II I
II IlBuilding State Fee )I
iBuilding Valuation: I
:r II Rad xnM ni r
TOTAL FEE
1�