HomeMy WebLinkAboutBLD94-01441 Cancelled SFR and Carport - BLD Permit / Conditions - 11/3/1994 ,♦. � ,'., s .� � #L" S � � tSi ',� �'+ � ^�t ?T w^ C� tit T.
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628
PLEASE PRINT �✓
#1 Ow C C Sv•✓ Phone# 2 7 5- 6 9 33
e Addres% -Cl=�,ALW LQ010Fire District#
city st W-A. Zip 291
Directions to Job Site w d,� �✓ o o 996z'¢'
9 T- 4= r C
Owner Mailing Address 40. 13 o x 17,6
City 6!"PF(.I I G ./ St I& Zip_-eS—,,6
Lien/Title Holder
Address
City St Zip
#2 Contractor Name .0.E. V 2Sc Contractor Reg
Address A,.v, s.4 Expiration Date/ �o
City 44 St W4 Zip.2f-76.4 Phone# 876-,ro ss
#3 If septic is located on pro' 9ct site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If res'dential, proof of potable water is required)
#4 IT No. i z- 3 2- - 2 - 9 ao 3 o
Legal Description_Poe r;•�_.. S�� 3 2 2 z �/ - t �✓
#5 Building Square Footage: (existing/proposed)
1st FI 2f 0 / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms— _/ #bathrooms
Garage / Carport 5�8' l (Circl ttach " r Detached?)
Other sq.ft. /
#6 Use of building NdM.c Describe work �c
w/AT-r -twCZ2 CA,PPoA
#7 Type of Job:New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
Purchase Price$
'j #9 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
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
0'
wfa
s
Re.
12
SF�c
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
i
Plumbing Fixtures ($3 each) Egg Mechanical Fixtures ($6 eachl
No. Toilets ? CIRCLE FUEL TYPE: Ga , Electric
_Bath Basins Heatpump, Other
l Bath Tubs ll� Units Fees
_Showers 2 _ Furn BTU
Hot Water Htr J _ Heatpumps
Lau Washer t Vent Systems
2—Sin (P � Spot Vent Fans 1.0�
_FI ns to.. Boilers/Compressors
_Laund Basins HP
Dishwasher No. Air Handling Units
_Disposal _ cfm#
_Urinals No. Protection Systems
_Other _ Auto. Fire Alarm Sys 50.00
Fixed-Fire Supp. Sys - 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
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 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $3�
MENCED.PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
y OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- 1 CERTIFY THAT I AM A CURRENTLY REGISTERED
MEN� TS OF"tHE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 1$27,AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTSREGU-
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.NO CHANGES SHALL BE MADE WITHOUT
MADE WITH`bUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTME T.
X OWNER X B �v
DATE DATE
xY: 'tep •; � s Date
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: q
NJ
Environmental Health:
Building Plan Review
Occupancy Group: �x- -Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit o?
Plan Check
Plumbing Fee 36.
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee It,
50
Other
Other
Building Valuation: TOTAL FEE