HomeMy WebLinkAboutBLD93-00538 Oil Pad, Retaining Wall - BLD Application - 4/24/1993 MW
Permit No.
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MASQN.CO4M
BUILDING PEI MIT APPL#CATI N
426 W. Ceft/P.O. Box 186, Shelton,WA 98584 427-906 1-800-562-5628
PLEASE PRINT
#1 Owner &44 D [10 Phone#
Site;Address Ff 'Doti IGt#
City 4_ St_11�.- :,.:r,�ip`
Directions taJob Site
Owner Mailing Address/D�,6tr l' ,4 ti,. Zz
City 5 EA T Ti St—Ld,-A=Zip
Lien/T'dle Holder
Address
City
Ft�l Dot bar IM&WVy St Zip
#2 Contractor Name Contractor Reg#
ress 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)
#4 Parcel No.
Legal a twn T.Q A tZE 51 Xd T
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Use of building r c Describe Work
?ti57�f' O`j O� O,Z'L //40 DC' PfL"s�rl c�[� t�R
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
ength Width Serial No.
#Bedrooms #Bathrooms Type of Heat
Purchase Price$
#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
Plumbing Fixtures(W each) Eft (S6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump,Other
_Bath Tubs Ng.. Units Em
_Showers ____ Fum _ BTU
_Hot Water Htr _ Heatpumps
,_Laundry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains NjL Boilers/Comnresscxs
_Laundry Basins _ HP
_Dishwasher Na. Air 8Mdft Units
_Disposal cfm#
_Urinals Ng,,, Fire Protection ys me
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 $ Otf�er
Gas Outlets
_ Wood,Gas, Pellet Stove
NOTICE: THO PEiIIIIOT II1ULL AND VOID IF
WORK OR G0 TM=11QN AUT'i_ IS NOT CW
1fIENC Yl�i._80`illY'3 OR W EJCTION OR Permit Basic Fee 15.00
WORK M!# 'E�R.ABA�i�D FORAPSVW
OF 1S �?AYWXr'A1t''TWAV'M-WORK IS �. TOTAL MECHANICAL $
a. .. WORK is BY
11EA14§'bF'* ESSBIS N.
OWNERS AFFIDAVIT CONTRACTORSAFFIDAVIT
1 CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM_A.CURRENTLY REGISTERED
VENTS OF THE CONTRACTORS REGISTRATION t.AW CONTRACTOR IN THE STATE OF WASHINGTO_N AND 1.
RCW i8.27,AND
IAA AWARE OF THE MASON gOUNW AMAWAREOFTHEORI�MUtNCEF�Ql11REMENTSREGU-
ORDINANCE-REMNIAEMENTS FOR WHICH THIS PER- LATINGTHEWORK THE PERMIT ISISSUED'
MIT IS ISSUED AND THAT ALL WORK DONE WILL BEN AND ALL WORK-DONE VILL- BE iN CONFORMAN6E
'CONFtR ETHEREWM.NO CHANGES SHALL BE THEREWITH.NO CHANGES SHALLSE MADE WITHQLLT .
`MADE WITHOUT FI INING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDIN E DEPARTMENT.
X OWNER X BY
DATE DATE
DEPA, TMENTAL REVIEW
FOB-OFFICE USE ONLY
App�,ei` coed. Hold
AWmW
Planning
Environmental Health:
Building Plan Review
Occupancy dtoup:1M Type of Const:
Fire Marshal:
Other:
Special Conditions: - FEES,
- Building Permit
Plan Check
Plumbirig:F.ee
Mechanical'Pee
_7 -,, ..
-- =,. Woo"Pellet Stove
Radon Monitor
Violation Fee
Site Inspection f3
Building State Fee y
Other
Other
Building Valuation: TOTAL FEE- 304°
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