HomeMy WebLinkAboutBLD95-1140 Cancelled Deck - BLD Application - 8/1/1995 Permit No. A6✓
MASON COUNTY ki
BUILDING PERMIT APPLICATION '?]4q'r2- I +0
426 Cedar/P.O. �ox 186, Shelton,WA 98584 427-9670/1-800-562-5628
PLEASE PRINT E !Ti
#1 er (, Gl/2C'e — i¢�5� Phone# y69 S'" O 7/'7
e Address O 1,446 Fire District#
ity e—z Z-,,=4 St Zip
Directions to Job Site
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Owner Mailing Address DtAl
City St Zip
Lien/Title Holder !`
Address
City St Zip
#2 Contractor Nam E Contractor Reg#C—QW'0-A109JE
Address -54r,o'Z O Expiration Date/ / 9<'
City �� O / Phone#
#3 If septic is located on proje site, in ecor
Connect to Septic? ublic Wa Su 4'
Connect to Sewer Syste Nam f System
(If residential, proof of po ble is requ )
33
#*egal
l No. I '� 23 - 00/ G,
Description T✓
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft.
Basement / Deck / #bedrooms / #booms
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
Describe work 7 x
#7 Type of Jo : ew Add Alt Repair Other 94!FfQ4eS
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year,1 Make Model
Length 's Width99 Serial No.,:54 99 5
#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
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways vV
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements basements Indicate Directional b N, S, E, W
Name of Flanking Street in relation t y of plan
>
Name of Fronting Street p
APPLICANT TO DRAW SITE PLAN-BELOW
C7p-AI Pi
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW-
90AD
Plumbing Fixtures ($3 e&cJ)j egg Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs ND_ Units Fees
Showers Furn BTU
_Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Systems
_Sinks Spot Vent Fans
_Floor Drains No.. Boilers/Com rep ssors
_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.
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OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
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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 OFTHE 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 A IN CONFORMANCE
CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH.NO CHANGES S L BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBT NG APPROV FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPART NT
E -
X OWNER X B
DATE DATE /
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t*O fIOI3 OILY Ac *Pt Icy w baf
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
F
roved Cond. Hold
Approval
Planning:
Environmental Health: C.h �D�YhAa�.tc
Building Plan Review t t c S "J ,L
S-
I -`t
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit C—fl
Plan Check (o S C7
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE