HomeMy WebLinkAboutBLD94-0961 Cancelled Storage Shed - BLD Application - 10/4/1995 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION cc�� •
a 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 ,v �10
PLEASE PRINT � 00
#1 er R1 Gk 6. Crt Phone#_ 2_0 215- g8y0
ite Address_ E. 17113 t4CX2i - p j,,?ALAE. 1�2 Fire District#
City Pt�,V St u.-) Zip q 85a 4
Directions to Job Site I r6 So�.1 1-'1i1 SkIsi n Cef 1kr V S} R+(xk+ Ck44c '
Sl�erwaod Q k. 13r 2 w Hrwse, on P,;Rh+
Owner Mailing Address 9. 01 Bt x 1 9
City AJ I U n St_('6. �Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name_ 1 �� - - Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic?_l1 O__Public Water Supply o Well K)b
Connect to Sewer System?__&1 Name of System
(If residential, proof of potable water is required)
# - Parcel No.� �-� - ,�rr (7c,,-�
egal Description l c�-� V L w �YZ �1 _ 3?,Z,�
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other S-Ei sq. ft.
#6 Use of building 9Describe work
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION 8etc/
Model Year Make Model V
h Width Serial No. it*
2
e #Bathrooms Type of Heat
Purchase Price$ .`SFRV1L+
CS
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond CM& 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)
i
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
P�oP.
7�
pole
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 a�ac _Fpg Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. UWja Fees
_Showers _ Furn BTU
_Hot Water Htr _ Heatpumps
_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
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 $
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT h
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 D PARTMENT. DEPARTMENT.
X OWNEPII"S' Z'0L_�am X BY
DATE DATE
OEFtt�L IJE 01'�L"Y#Ac'�ept �Y" O�t� .
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
i
i
iE
i
i
Environmental Health:
k
Building Plan Review
Occupancy Group: Type of Const:
Fire Marshal:
Other:
FEES
Special Conditions:
Building Permit 2oz
Plan Check (5-�
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other v
Building Valuation: TOTAL FEE ] -
THIS PARCEL
INCLUDES
PLANS, BLUEPRINTS
OR OVERSIZE
IMAGES
LARGE FORMAT
IMAGES HAVE BEEN STORED IN
FILE CABINETS) UNDER
PARCEL NUMBER
PARCEL # a0zr1a
cnse # $LD 9µ- l�ilol �I