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HomeMy WebLinkAboutBLD95-1225 - BLD Permit / Conditions - 8/30/1995 !' Q JLC f ( 4G O41 ' 1 ft4r"„ Permit o. MASON COUNTY t� BUILDING PERMIT APPLICATION 426 W.Cedar/P.O. Box 186, Shelton,WA 98584 427-9670 1-800-662-5628 PLEASE PRPLEASI FRNT #1 kwner J 4j =. Phone# drss r Fire District# city ) St Zip Dire1 n tc o Site �- Owner Mailing Address city L * ____ ________StZip JLj , l i n Twa 1older Address city St Zip #2 Contractor Name ontrec bf eg Address Expiration Date City St Zip Phone #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply x _ Well Connect to Sewer System Name of System of residential, proof of potable water is required) rcel : Le el Descriptio #5 Building Square-Footage (existing/proposed) 1st 6l, J N 2nd Fl 1 3rd `l 1 Lott Base ie fl l Deck #bedrooms._ / #bathrooms _ms Garage Carport / (Circle:Attached or Detached?) Other sq.ft. #6 Use of building ry Describe work #7 Type of Job: New Add Aft Repair. Other #8 MOBILE/MANUFACTURED HOME INFORMATION ATION Model Year Melee Model Length j Width Serial No. #Bedrooms #Bathrooms. ,Z Type of Heat. Purchase Price , x Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other ,art • Show following on the site p1an- Lot Dimensions ` Flood Zones Existing Structures ;r 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) 1 Name of Fronting Street in relation to plot plan APPLICANT TO DRAW"SITE PLAN BELOW APPLICANT TO DRAW-TOPOGRAPHY PROFILE BELOW LLJLLt-1wS Plumbing Fixtures($3 each, F Mechanical Fixtur ($6 each) No. Toilets CIRCLE FU PE: Gas, Electric, _ Basins Heatpump, then Bat s N i s Fees _Showers Furn BTU _Hot Water Htr Heatpum s Laundry Washer Vent Syst ms Sinks Spot Vent Fans ___Floor Drains .. Boilers/Ccm r r _Laundry Basins HP Dishwasher Nom. Air H n li a Units - -Disposal cfm# Urinals Fire Prote tion Systems ,_—Other Auto. Fire larm Sys 50.00 Fixed Firi Supp. Sys 50.00 Permit Basic Fee .00 Au ire prink Sys 25.00: TOTAL PLUMBING $ No... Other 7 Gas Outle Wood, Ga , 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 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MEGHA ICAL $ OF 180 DAYS AT ANY TIME AFTER WORK' IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFI AVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I A I 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 AMAWAREOFTHEOR INANCEREQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK F R WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DO E WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH.NO CHA GES SHALL'BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING AlPROVAL FROM THE BUILDING THE BUILD DEPARTMENT, DEPARTMENT. X OWN XBY DATE~ DATE FAR OFFICIAL USE ONLY:Accepted by: ate.: DEPARTMENTAL REVIEW FOR OFACE USE ONLY FApproved! Co id Hold Approval Planning: Environmental Health: .mr.».+..... :tee i i 1 Budding Plan RevIew fi s a � i t � Occupancy Group. Type of Cent: ,...e. ....,..n..m.�..............,...W....,......�.+.........�r��.......:.......m,�_...�............, ....„.........,.,..,.,........mow.,.» g.........-...,....,.«�._.. r ewe .�. ...®,,..� »...w..... .0......�.�,«......�:.:;,; .,;,.,...:.m..... wa,u,d», �,.�............. �..., Fire Marshal: l r y r } z Other: FEES Special Conditions: Building Permit Plan Check Plumbing Fee Mechanical Fee Wood Ga Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other } Other 7Buifd�ihgValuation: TOTAL FEE C,� 4 a r 0A sae'. c / 0O r r.. � r �, tw uM �� r , { , DO Oa U 00 tYu'ti wx. `sfi� M,w .,m s s .F Ww,r �,n 4 'wit N^ „J5„ 4 t CONCRETE MECHANICAL MOBILE HOME Facings-Setback date by Ribbons date by Gas Piping date b) L. . Foundation Walls date by Set up 1a...E,'?� date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON C©UNTY DEPARTMENT of HEALTH SERVICES Shelton,Washington 98564 (360)427-9670•Beifair:275-4467 ENVIRONMENTAL HEALTH PERSONAL HEALTH WATER QUALITY P.O.BOX 1666 303 N. FOURTH P.O.BOX 1666 To:_________________________ Date: `&T L1vc , RM-. Your building permit cannot be issued by Mason County Environmental Health until the following items are completed and turned in: { } Application of Water Adequacy .._ { ) Approved septic system and approved septic design. ( ) A complete and accurate scaled plot plan { ) A septic tank pumpers report, within the last three years Other: ' NYC, C' i L (- tss(O1&t . 1KL c 2sEr vet- 1 r-cxL4 � PL4 1hAc /'i It 0 (AA '4 NOTE: To speed the processing of your building permit, please include your building permit..number and parcel number on the inforamtion you provide. I have provided that information below. Building permit # l ; t2..2i Parcel # 2{ -is - C 1 0 If you have any questions, please feel free to contact me at 427.9670 ext. 554. Pam Denton Environmental Health Specialist II c r:f {