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Home My WebLink AboutBLD99-0979 SFR - BLD Application - 10/25/1999 QQ.c� je PERMIT NO. BLD l 1 l ASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner IN Contractor Name��Pnx i, ti e K �nn,�/ Mailing Address�,� t "1 c I rl,e K kcj . Mailing Address P.n, c "75'6 City,�bpI{n,01 State chi { Zip Code City {1 ,t 1 State !, ,A Zip Codes t Phone(3111 %J4-,fit)/OOther Ph.( Ph.( Other Ph.(� Lien/Title Holder �4 W f Contractor Reg. # F'M a ry c c- c 1:2 5 L o Address Expiration / / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic_)(_Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. ,'n �j ��_/ / F�n Fire District Legal Description 7Ckd L k G n{ 1 h i, IU LU ti u) Site Address(Please include street name, street number and city) LA ) I '14 0 /.-1 E(L' Directions to site 1 /�.-/. Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water (Name) A) A Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building F 4to.-e E,i y -,114 at 44C Describe Work No. of Bedrooms.q._No. of Bathrooms_ SQUARE FOOTAGE-1st Floor t 5t7o 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage'' Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date /0 ' X —Date— r 67 FOR OFFICIAL USE BEYOND THIS POINT y6 Accepted by Date& p Submittal Amount Due Receipt No. DEPARTMENTAL`REVIEW APPROVED DENIED CONDITION CODES Building Department MO Occ Grou U I Type Constr. U td Q Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $-'1 �0(1 FEES Building Permit Fee 61 35 Site Inspection Plan Review Fee 5 6 UFC Plan Review Fee Plumbing & Base Fee i5 C) Public Works Review Fee Mechanical & Base Fee gs ,� Other ¢ ,5p Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( �C(oo,`{6 ) k•':.w::c 'r' ...... :$f::�.�ii2u:%2,.. ,t>t:x...<•..:xau::a»::w rw••,:r,•?••a.. TOT :: < .:::.:m .,,». w .:. <:::a: AL FEES PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair(360)275.4467 Elma(360)482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner t,,(f, /4„ )14P-.n I ( L<,o N Contractor Name )-Arn,c. 'koek Cd VS&ie,r Mai!ipg Address LcJ 1 `7 0 C'!/1,P le Mailing Address IO.G'. /;,ox 7Sr City 11 State t 1 'H Zip Code City r)I E + how State ' r Zip Code 9 V f Phone �G.C) a T -a,//o1)Other Ph.(_ -,nn_j Ph.( , ) 7,93-,�QRI Other Ph.(_ T— Lien/Title Holder ��A m k Contractor Reg. #CC01 Qke r►,C c c 1.�) 5 LO Address Expiration Q 6 / SEPTIC INFORMATION-Connect to New Septic Existing Septic—,Z _Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. %' 3 / / O o O 1 2 Fire District Legal Description �- Site Address(Please include street name, street number and city) Directions to site ke y a /U Is your property within 200' of the following: Body of Water (Name) 6 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or JEuffs PYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets 14 _ Type of Unit No. of Units Fees Bath Basins 14 Furnace _ 13,PS Bath Tubs 1 1 Heatpumps Showers �_ 1 Vent Fans Water Heater _� 7 Propane Tank 4.50 Laundry Wsher 7 Gas Outlets (Rw") S.SD Sinks 17 Wood/Gas/Pellet Stove Dishwasher �_ 7 Direct Vent? Other_ _ Other Qf►,v r W000 4.50 Other uoSE 9, es 5 Other Base Fee aD.0O Base Fee •PO TOTAL PLUMBING QS.Oy TOTAL MECHANICAL kS.?S A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date ! '.a '`� X Date FOR OFFICIAL USE BEYOND THIS POINT Accopted by Date Submittal Amount Due Receipt No. AEPARTMENTAt:R0gEW APPROVEQ DENIED CONOITIQIV CODES Building Department Occ Group Type Constr. Planning Department Other Other Permit Fee Site Inspection u Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES PERMIT NO.: BLD 'I `,(Dqv 00MASON COUNTY (p ?0 BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 S eIton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( ) Other Ph.( Ph.( Other Ph.(� Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PJ INFORMATION-12 digit Tax Parcel No. rict Lescription Siess(Please include street name, street number and cityDis to site 44 r ' A Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Bu Describe Work I inQ IJ,11 l No. of Bedrooms No. ot Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms N Bathrooms Type of Heat Purchase Price $ R �} Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 0 AYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X i Date X Date FOR OFFICIAL USE BEYOND THIS POINT r, Accepted by 'i Date.& Submittal Amount Due Receipt No. DEPARTMENTACREVIEW APPROVED L DENIED CONDITION CODE$ Building Department Occ Group Type Constr. Planning Department S 00lQ 9V oac Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) �ivti>:iii$iiiii:•::ii'i$i:{i:•:LiJii:?4:f4`:ii:4::•:::•i:?�:^: TOTAL FEES is?:•:::•::>:i:i:i>:i:<J: :4,L':`'i:•vtitiKL::;;::;:•}:h%i:':i::.�l.::v.:vv:is•i::4i:•:{Lt4:v:::.iv}i:•i:•. .... .. MASON COUNTY PROJECT SITE INFORMATION Case No. Name T PARCEL NUMBER Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line's I Fadjacent property line i 3 / ' I 110 I I i I i V I r"l 1�j4�L -I`L I I I I adjacent property lined I "-i� + I E-adjacent property line U�4,-11 �, {� , ,- �t Ian cc�u 5cr� SAMPLE SITE PLAN � _. 1 adjacent property lined 3io� _ _ f-adjacent property line v so (-r�SCauE S6.A_co.rAL I a L I HOM tr Gci�� CrzF�K I PrioPo�tn Sept.c �I I I VACANT o I(C G0.cPosCf] so I \ A&R=LLLTtifLAL F-40 Yp- I I B o' —mot I \ I I t...�•_t.L I adjacent property lined ; A . \; Fad acent pro ert line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE di 5+a—ce. to Sr!•rtt�tL,�Y� di�Iar�LG f0 SIoQa. ta¢ dit+ ft t o t Signature Date MASON COUNTY PERMIT ASSISTANCE CENTER PLANS SUBMITTAL CHECKLIST Owners name: Date Project: Reviewed by: Documents: \ Accurate site plan attached to each set of plans (setback requirements) Topography attached to each set of plans Energy Code application (fuel type ) Application complete (Mechanical, plumbing, wood stove, etc) Contractor registration# OR provide written notice "Hiring a Contractor or Remodeler Engineering/design criteria: snow load, 80 mph wind/exp, seismic zone 3 Construction Plans: (3 sets) Plans legible Recognized scale Cross Section Elevation Roof framing Deck framing --)L Foundation plan Floor framing,all levels Floor plan (use of rooms) DETAIL: (Include wood species and grade, i.e. DF#2, HF#2, PT, etc.) Roof framing detail (species, size, & spacing) CK Wall framing detail (size, species, & spacing) DE*rl Bearing wall ht exceeding 10 ft requires engineering CYN Floor beamstsizg,-species, &snacina) Floor joists (size, spacing, species) CSC Header and beam (s_ize & species for openings over 4 —�C Foundation (size, steel, anchoring) C Concrete walls (Reinforcement detail, >8 ft requires engineering) Non-conforming framing (steel structures, foam core, etc. requires full engineering) ok Fire separation walls shown on plans — ( k� fQ{�a.rkflo^ Point loads identified, calculations provided if needed. Slab insulation shown Stairs/Handrails on stairs with more than 3 risers Guardrails on landings greater than 30" above grade cr,(:Z) Location of furnace identified on plan, where? Propane appliances in basement (3" screened floor drain to o/s,2 combustion vents) Fireplace/Stove information shown Window sizes marked Covered porch detail (Use ICBO Chapter detail? ) bKZ_,Z Braced wall lines clearly marked on plans Interior braced wall lines required for boxes greater than 34 ft y( Do plans meet UBC prescriptive braced wall line requirements?-i UNUSUAL SHAPES: Roof or floor extend more than 6_tCgIbraond brace wall line or ICBO detail. (2320.5.4.2) Openings greater than 12 feet or 50% of the east floor area. (2320.5.4.4) Braced wall lines do not meet in a perpendicular direction. (2320.5.4.6) Braced wall lines offset the vertical plane from the foundation (2xl 2 NTE 48", 2x10 NTE 40", no offset in 2x8 or smaller) (2320.5.4.1) Floor and roof is laterally supported by braced wall lines on all edges (2326.5.4.4) The end of a braced wall panel extends more than 1 ft over an opening in the floor below (BWP may extend over an opening 8 ft or less in width when the header is 4xl2 or more, U.B.C. section 2320.5.4.3) Engineered documents (Engineering required/included? ) Design criteria-snow load , wind 80 mph, exposure C, seismic zone 3 Engineered data transferred onto the plans Structural general notes, 2 sets Stamped structural calculations, 2 sets Washington State licensed engineers or architect signature and eng. expiration date COMMENTS: FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275 4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT IN/FORMATION CONTRACTOR INFORMATION Owner U), lto ,>/qpn lk" I L5d _ Contractor Name 17Aenyc1, r'keek (_ tiiys fjPr�fis f Mailing Address W 1 7 O C/,4k le d Mailing Address 7S,? City Stitt✓ )ti N State Lu 14 Zip Code 9 gsEy City M e f he, ,-,-, State k41A Zip Code V y e sy Phone(36& q j Ph.C____) Ph.( Other Ph.(� Lien/Title Holder 5/i m Contractor Reg. #CL01 Address Expiration ! _/ r� / _ SEPTIC INFORMATION-Connect to New Septic___�, _Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. -1 0 i / / (20 0 / 2. Fire District / _3 Legal Description W Site Address(Please include street name, street number and city) Directions to siteaAkqa/U i Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric X Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace X — Bath Tubs 1 Heatpumps Showers _� Vent Fans A— Water Heater �_ Propane Tank Laundry Wsher Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher �_ Direct Vent? Other — _ Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. ix Date /0 ""�' '`�`/ X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. iJ ART:fti+EEP1TAE.#2 VtE f: APPROVED: DENIED COM1tDiTIClNCt)0�5'. Building Department Occ Group Type Constr. Planning Department Other Other .... SEES ....... . Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES I FORM MUST BE COMPL D IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Namehllf. ga u4 an PARCEL NUMBER 3 a?D3! - J A -ann in. Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences N Existing Structures Driveways Structure Setbacks Shorelines WW Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System Is DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 I I Fadjacent property line kaQ I I I I I I I I I I I I �� tJTIC I I PO LV 1 I I I I F�cl I I I )61 I I I I I adjacent property line-> I 6CC I Fadjacent property line AM SAMPLE SITE PLAN �`i3�II `Wei I adja�nt property lined 2LO� _ E-adjacent property line F I v 30' ra�scRve �E-3o:._,I .9* .J AL I a 77RR _�PTSL__,I J- I I MOM 6 n I GsEw_ I ',crux I j Prao PastD sa pt!c �I I 1 VACI.tvT I 1 C RAf-6 I o I � CaoPoaCD T I ASR=L�LruJiAL 50 I F--4p'-�1 \ y0• I I , / 1 � I /00' I I L—e-LL I I I I I a� /DO' 711 adjacent property lined i 4 Fadjacent ro ert' line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE d13t�nca. to ruct�►�t &St'ar.LL to Slops. tc¢ dis+ane.a_ to t. , Sign a Date APPLICANT NAM a^ &1�j t2z DATE: 2 BUILDING PERMIT CHECKLIST SITE ADDRESS If site address has not been issued refer the customer to Community Dev. ext 291. El FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to map located at counter. El DIRECTIONS TO JOB SITE Needs to be as complete as possible (i.e. major roads, is house on left or right side of road, etc.). Be sure to read for clarity (Landmarks, signage, owners name on mailbox, etc.?). E] LIENITITLE HOLDER Who holds the mortgage (Bank or name of private owner holding contract)? El CONTRACTOR REGISTRATION # AND EXPIRATION DATE This information needs to be provided. The Building Department may be able to research expiration information if customer does not know it. We must have a signature in 1 of the 2 boxes, either the applicant or the contractor. SEPTIC RECORDS New systems must have test holes dug prior to submission and Septic Application must be filed and paid in full. A B WATER COMMUNITY 1. , ,PRIVATE _ 1 DESIGN APP NG EXISTI . U SEPTIC �_._ �y�� DEV REMODEL NEW RMIT ASSISTAMCE STATUS IS THIS A REPLACEMENT UNIT? YES—+ NO IF SO: MASON COUNTY BUILDING PERMIT APPLICATION SECTION #5, BUILDING SQUARE FOOTAGE, MUST BE FILLED OUT COMPLETELY. AND: SECTION #6 MUST CLEARLY STATE, "REPLACEMENT UNIT" El PARCEL #/LEGAL DESCRIPTION I!l1CHECK PARCEL NUMBER FOR PARCEL FLAGS!!!! Parcel # must be included. If number is not available contact Addressing at Ext. 291 BUILDING SQUARE FOOTAGE Clearly show existing square footage and that of which is proposed. If there is a garage, verify whether it is attached or detached. Include square footage information for mobile homes.(ie. 10X20=200 square feet.) USE OF BUILDING Residence, garage, greenhouse, designate if it is commercial. DESCRIBE WORK (i.e. mobile home addition, addition to a house, etc. . .► El TYPE OF JOB Verify appropriate boxes are marked. WATER ADEQUACY For new residences and mobiles. PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST AND BACTERIAL TEST. If they are on a public water system, check for signature to verify that the system is not on the State's "out of compliance list" 1 MOBILE HOME INFORMATION r, please put factory order #in mobile home serial #. If unit was Verify appropriate boxes are marked. If factory orde assembled prior to June 15, 1976, refer to procedures handout for "Obtaining Installation Permits for Mobiles assembled Prior to June 15, 1976." Q FLOOR PLAN Manufactured/Mobile homes require a floor plan of the home be submitted. 9 FEE DUE A fee of $175.00 is due when application is accepted. This is half of permit base fee of $350.00. SHORELINES/CREEK/WETLAND If property is within 200 feet (including adjacent properties) of Shorelines/Creek/Wetlands, #9 must be complete. If none of the conditions are present please enter "na" or "none". SITE PLAN DRAWING MUST SHOW THE FOLLOWING: * LOT DIMENSIONS * DRIVEWAYS * EXISTING STRUCTURES * SHORELINES * STRUCTURE SETBACKS * WELLS * SEPTIC SYSTEMS * NAME OF FRONT STREET * PROPOSED IMPROVEMENTS * EASEMENTS * NAME OF SIDE STREET ALSO PLEASE MAKE SURE DIRECTIONAL IS FILLED IN ON APPLICATION IF PLOT PLAN IS ATTACHED TO PLANS OR IS NOT ON CARBON FORM, (3) THREE PLAIN PAPER COPIES ARE REQUIRED. TOPOGRAPHY DRAWING If property is flat write "flat" on the topography section. If house or structure is near a slope or hill, drawing must reflect this. This should show an accurate side view of the property. El PLUM BIN G/MECHAN[CAL This form must be completed for any structure with plumbing and mechanical excluding mobiles/modulars. OWNER OR CONTRACTOR AFFIDAVIT Owner or contractor must sign affidavit statement and date it. ACCEPTED BY Whoever is accepting permit information must sign your initials and date form on the bottom of page 3 or use date stamp and initial on back of permit. PRINTS Need three sets of prints unless it is a stock plan. For stock plans, we only require one copy. Commercial projects require four sets of plans. WSEC & V & IAQ CODE Required for all residential,additions and commercial buildings. Energy Code compliance form needs to be COMPLETED. Verify heat source (no wood or pellet stoves are permitted as primary system). Window schedule must be filled out and reflect what appears on submitted building plans. If applicant has decided to go with the PUD in a Long Term Super Good Cents program, we require a copy of the signed agreement with the utility. (� ROAD ACCESS PERMIT If you will be accessing your driveway from a County road, contact the Public Works Department in Mason County val. Building I, 427-9670 extension 450. Access from State Highways requires Department of Transportation app Contact office (206)895-4753 (Port Orchard). Checklist.2 December 17, 1998 2 Trish