HomeMy WebLinkAboutBLD96-00650 Cancelled Mobile Home - BLD Application - 6/3/1996 Permit No.
MASON COUNTY �--
BUILDJNG. PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT n� 9
#1[�rCite
r / " l 6 ��pe f ��`��-� Phone# 22�(Q s-� 3 /
ddress 4 8 �cl�S 1>/ Fire District#
St wA Zip
ions to Job Site
ao ;4)
. 0 _ 3r a
Owner Mailing Address
City St zip
Lien/Title Holder Q0 �n
Address
Clty St Zip I-,
#2 Contractor Name U&J o L C� Contractor Reg# �tV DLQ�r Dm
Address �o� 3 /v(.c� Expiration Date l_f`L l_21
City St Zip `i�3 3S Phone# ;Z�
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel N - - p� �2 S-3 J e
Legal Description 9a?)1b—'I V)OECao
#5 Building Square Footage: (existing/proposed)
1st FI / / 3 2nd FI �� 3rd FI Loft -T—
Basement Deck #bedrooms /_3 #bathrooms / Z
Garage / Carport / (Circle:Attached or Detached?)
Other�� �1 Q sq. ft.ZOL,"� � +i
#6 Use of building �z'����A 1 FZ.Cl C Describe 4[+�1c
6U v
NRP C.
#7 Type of Job: New Add Alt Repair % G
- AN
�10
#8 MOBILE/MANUFACTURED H ME INFORMATION
Model Year Make ,• od
hh el
Lengt Width Serial No
# Bedrooms 3 #Bathrooms 2— Type of H at ,c4 c. � �
Purchase Price $ 60
#9 Indicate by circling the applicable ource� if any water is on or adjacent to subject property:
River Pond Creek Stream tlan Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot 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 Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3.25 each) Fee Mechanical Fixtures ($6.50 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Systems
Sinks _ Spot Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins _ HP
Dishwasher No. Air Handling Units
_Disposal _ cfm#
Urinals No. Fire Protection Systems
Other _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 16.25 _ Auto Fire Sprink Sys 35.00
TOTAL PLUMBING $ No. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.25
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. N CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBT APPRO A F M THE BUILDING
THE BUILDING DEPARTMENT. DEPART
X OWNER X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: 1 t 4 Date. C1 ) 1`( Y
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review 197J4 Cl
Ild
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other Fee-, , D�
Other
Building Valuation: TOTAL FEE
81 7 6' WETLANDS {GARAGE
11, 10' 9' (SWAMP) /I
5 MIN. PUMP 1 ` HOUSE
ST P
LOCATI FOR INT.SAND FILTER INT.SAND FILTER
A 3 BR H USE G Ob i
GARAGE (yS ) l0
4'X 24') FF ELV. = 0.0' 10' N.-1 \ PUMP2 1 MI ;' •
I
Q I PRIMARY&RES. '
10'MIN.2 �, INVERT ELEVATIONS w DRAINFIELDS
Y VIES TO B CE RALS PRESS RES FIN.FL. =10.0' 0 100,
r II
1 t ¢ i
STUB OUT =7.0'
SEPTIC IN =6.5' SET-BACK
SEPTIC OUT =6.25' 15'
PUMP IN =6.9
LAT IE#1 =7.0' % I
�•` �\ LAT IE#2 =7.5' W ILL
LAT IE#3 =8.0'
LAT IF#4 =8.5' 1
o OBSERVATI •N PORT \ �'° N ✓ j i
SEE NOTE 2 (j) �� 1
i
• \ � BENCHMARK ' `
F� 12"COVERT I
d \ OBSER ATION PORT-20.a ,` - i \\ (ROAD RUN-OFF TR NCH)
SEE NOTE 24
SCALE
____ BLACKSMITH DR. 10' - -
o ,Q 29 � 71 6' -- --- THIS DESIGN IS NOT A SURVEY
-1-
��
8, ALL PROPERTY LINES AND DIMENSIONS, AS SHOWN,
PLAN OVERVIEW MAP ARE FROM INFORMATIONN SUPPLIED BY THE CLIENT
OR COUNTY OFFICE. E ASSUME NO LIABILITY FOR
\ 11' 10, 9' W
( 1"=100' RECENT VARIATIONS
ASCERTAINED BY ACTUAL OR MORE
f 1 "=3 0 12' _ 1 --
PE STAMP � COMPANY
rw �-SOIL PROFILE PRESSURE LOSS (PUMP 1 W SEPTIC MASTERS
): OF
(TYPE 4-SANDY LOAM) ELEVATION 4.0' v ry � �f 154212th Lane (206)549-2214
(RESTRICTIVE LAYER 35"-TH#1-2) TIGHT LINE, MANIFOLD, LATERALS 1.0' Fox Island WA98333 (206)207-1142 PAGER
TH#1 RESIDUAL HEAD 2.0' i '� SITE ADDRESS APPLICANT ADDRESS
0"-35" SANDY LOAM TOTAL 7.0' PAR#4751-000-029-01-09 Mr.&Mrs.Moms
(FLAME MOTTLES FROM OLD BURN) ORIFICE SIZE & SPACING 3/16"@ 3'C.C.
ORIFICE ORIENT. 12:00 UP 2i724 MAILING ADDRESS
TH#2 DRILL 2 EACH LATERAL 6:00 DOWN p SQL, � P.O. Box 708
0"-35" SANDY LOAM TOTAL ORIFICES 20 '�'�,� G'IS'j�R slzE DWR NO. Keyport,WA 98345
TH#3 PUMP 1 SHALL BE CAPABLE OF 23.6 GAL./MIN. V`S"ONAL G B 960421-1 (�)396-5652 W
0"-31" SANDY LOAM 7.0 FEET OF HEAD DRAWN BY SCALE DATE SHEET
EXPIRES 4/6/� __RICK NAHUM NONE 96/04/21 20F2
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DEPARTMENT OF LABOR AND INDUSTRIES
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THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED J J
GPNERAL
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