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Home My WebLink AboutBLD93-1535 Cancelled Carport - BLD Permit / Conditions - 10/6/1993 gLb9�-I 5 MASON COUNTY Per �Q BUILDING PERMIT APPLICATION �C PLEASE PRINT 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-56628 SEP 2 Z 1991 #1 Owner 06 ehl— L7 F Phone# 2d4 Site Address_ E - 20 S hletzy00 /20. Fire District# City /Y A.1 St_;,cJ� zip 5L2� Directions to Job Site ERvM 3 R - To HQh Gv©d To 40 ocs )0 1 'yd Woe -C o,r ,Qi 91Y Owner Mailing Address city _ 4l/Y"U St_W4 zip 2&5; ?S/ Lien/Title Holder , + o t/'t D JUoY�S' Address Rep k S Clty 9//YA-) St #2 Contractor Name Contractor Reg# 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) 12230 S O 000/8' #4 Parcel No. _- 1 _ �- Legal Description Z y/e j-W0e,-a ppgA` j9,y _ / 3 Z K l o f - /g #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft—/ Basement / Deck / #bedrooms / #bathrooms—/ Garage / Carport 3 94 / (Circle:Attached o Detached? Other sq. ft. / #6 Use of building 29AX cO 2 Describe work Z/A-- c.-f— ACL,j #7 Type of Job: New )t Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make Model Length 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 Show following on the site plan t Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells S Proposed Improvements Easements Indicate Directional by (N, S, E, W) Name of Flanking Street in relation to plot plan Name of Fronting Street PLICANT TO DRAW SITE PLAN BELOW — / J APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW /� Plumbing Fixtures ($3 each) Fgg Mechanical Fixtures ($6 eachl No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No.. ILL 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 H lin ni _Disposal cfm# _Urinals Fir r i n m _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 $ . 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 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 DEPART DEPARTMENT. X OWNE 4dX BY DATE - '�� DATE FOIE OFFICIAL:USE 0NLY:'A ccepted by. Date: `�� DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: �� Building Plan Review Occupancy Group:/✓M— — Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check T. Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee t{ sQ Other Other Building Valuation: TOTAL FEE Q .00 40 O 000ol 0 O (C) o C Q N CQ- C oOo Q �j � Q L� OD - i 000 X OD O O` n S \ / O QL O QN z Q 00 � m o a 01 Q i Do i i i i i i