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HomeMy WebLinkAboutBLD95-1502 Cancelled Fence - BLD Permit / Conditions - 4/8/2009 Permit No. s -60A MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT n / 'i 1 #1 Owner /� C�/s kd-rr 1 0-0- c S Phone# ^7 J 0; - ` No Site Address g. Hw Fire District# City NCI. A- - St (�� Zip 85 a Directions to Job Site M1,40 5,:P u 4-h pllu5-t i -91 Owner Mailing Address D City Ally Tn St_�!� Zip sot Lien/Title Holder Address Clty St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If Isatic is located on project site, include records. Connect tic? Public Water Supply Well i Connect to Sewer m? Name of System (If residential, proof of potab er is required) #4 Parcel No. - Legal Description 9 P #5 Building Square Footage: (existing/proposed) 1st FI / 2nd Fl / 3rd FI / Loft / Basement / / #bedrooms / #bathrooms / Garage / Carport (Circle:Attached or Detached?) Other sq.ft. I #6 Us of building Describe work 61 #7 Type of Job: New Add Alt Repair Other #8 MOBIL UFACTURED HOME INFO ATION Model Year ake odel Length Width erial No. #Bedrooms # rooms Type of Heat Purchase Price s I #9 by circling the applicable source if any water is on or adjacent to subject property: River P nd 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 i APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW I 1 i 3 Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) _Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other _Ba Tubs No. UakFees _Showers _ Furn BTU _Hot Water Htr _ atpumps _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 Per ' asic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. r Gas O lets 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 MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT 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 DE ARTMENT. DEPARTMENT. OWNER h ( X BY DATE b DATE F Ft+IMF I fAL 11SE t�..... Pt d b Oath --..ram ni r+ rrrrsrri Sri rr DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: )c�5�q Environmental Health: Building Plan Review LC Occupancy Group: Yype of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit ?- Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee 11. 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