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HomeMy WebLinkAboutBLD95-0818 Deck - BLD Application - 6/13/1995 S MASOVOUNTY BUILDING PERMIT APPLICATION ��� 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 D PLEASE PRINT O wn r AiPt c Sfl,,.,o Girave t d� _Phone# 3�y ��l Address E 1-7 3 W�N+OJ A O '.�. c i 2 U� Fire District64 # ity 56-14av�- St Zip Directions to Job Site N�rt5- �-c �t ��✓� �k� � 1 e1,. Owner Mailing Address 7IKl klr°e' ad City 01YrAP6't �'`'egln St zip �18� Lien/Title Holder Nor Address City St Zip t " Contractor Reg# Contractor Name Address Expiration Date / / City St Zip Phone# #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) tga l No. 2 - b 7 _ s«o 4 3 Description'Op. N�+-f s�-�.►c tom' `^� �� l�� 3 uilding Square Footage: (existing/proposed) G 1st FI / 2nd FI / 3rd FI / Loft / Basement / r 39 2'/ #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / I `` Use of buildingto Describe work 0 e of Job: New Add Alt Repair_Other Type S #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make Model Length Width Serial No. #Bedrooms #Bathrooms Type of Heat Purchase Price$ 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 Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 eWhnl o. Toilets CIRCLE FUEL TYPE: Gas, Electric, ath Basins Heatpump, Other _Bath bs No. Units Fees Showers Furn TU _Hot Water Htr HeAtpfimps _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 Perm' asic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Gas utlets Wood, s, 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 $ MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. r 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 OF THE 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. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTM DEPARTMENT. X OWNER �/ %� A X BY DATE 6 /3 —Y�;- DATE C �t}FIEL USA C)NLY Accp' rt tw? t -- DEPARTMENTAL REVIEW FOR OFFICE USE ONLY �Irov ed , Cond. Hold yr,9 Approval Planning: �4eh- � t b oriti 4xtA t+„'� eizl, Environmental Health: �g Building Plan Review v Occupancy Group: Type of Const � Fire Marshal: Other: Special Conditions: FEES Building Permit Q i Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other r Other Building Valuation: �� TOTAL FEE �b Cr hic'l; I ttr-1 J 0. e !, e ! I�t-1)E t? 7 J lei e_ i Pcwc)✓r I) 1 VI)IIJ 7 '} 7 i N 7 - 1.; .• �J.- F:�. - L�UIt u ,vim - ��fHi lv, , u1=- > f+.t aO�•G3 6 R.. .ny }� ..a��. //� Pn /A .T. rr a J �,w n 0 r `.p %w O W .tis m t. © W r iY! t!? 4Fs JJ w V" O "'1 © S \♦ O W o r ill[ Gs rKn r~•+ �' ?TT. D C 0 b �" �" rTr a ." >:"? rC r w L -r no =Co� .-. � > ?J O 0 -�- -i ?f C3 C3 > O D M M O V O M A -4 D rxz. s co. cy rn --4 7Mr- ! t M €'71 Z0 mr Cm Cmm 73 C7 f CI, Qs CSG, coo i -- - - - -'E7c rnr M 0 rDOoo .. *er♦ -"i :v . Z a)I2 N t Ptf .► . ..1 C "n T€ C3 a) -! Z: ♦M— r� W CPS € a t . i r "n D iO. 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