HomeMy WebLinkAboutBLD93-1703 Parking Platform - COM Permit / Conditions - 4/13/1994 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner Phone#
Site Address r-- =VT 1 14ijbft 3Fire District# 2city laeAwy' J st WA Zip !%526
Directions to Job Site &tMnt1 b 1A17 eik, f4 ak� Se and a� Zinc rArAmumi f:4
c�t hn inreu,t 3. 51hh of
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Owner Mailing Address h1oft huft %6hw vNift*-4D13
City �•p.VDY- 16*1 , &A:fZ&i Y St-WA---Zip.905z'b
Lien/Title Holder NX
Address
City St zip
#2 Contractor Name • JJQ42:firAL 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)
#4 Parcel No. r?0 - 000 01 S
Legal Description L444 '6%-a-M of Sam B.:ffirAV& 14briz j 6aakn TUIC:t!j [h 15&JiTm*41 f 52.9
I Wte.7t, VVM., fn DM fair, 1&50n COU"f5WOL.5 h in5tbyi
#5 Building Square Footage: (existing/proposed)
1st FI 2nd FI 3rd FI Loft
Basement Deck #bedrooms #bathrooms
Garage Carport (Circle:Attached or Detached?)
Other *hUt Tutu a&sq.ft. 5W F-
#6 Use of
tw* mze*s 6 -F7A.+ULkZ kU�Wn-Describe work
-:6
12IJ14KC, Pf 1-6 vby i6w
47 Type of Job: NewY Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
Purchase Price$
'49 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream (EiD 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 6y (N; 'S, E, W)
Name of Fronting Street in relation to plot plan'
Na g
APPLICANT TO DRAW SITE PLAN BELOW
6ec, 4YYm - C-2 in A#OYA DV&4 r19$ - I b•15-13
APPMANT TO DRAW TOPOGRAPHY-PROFILE BELOW
Plumbing Fixtures ($3 each) f= Mechanical Fixtures ($6 each)
JN
No._Toilets N/A CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. llr jiLa F�
Showers Furn BTU
_Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains Ng, Boilers/Compressors
_Laundry Basins _ HP
_Dishwasher No. Air Handling Units
_Disposal _ cfm#
_Urinals Ng, 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 $ N.Q. Other
Gas Outlets
Wood, Gas, Pellet Stove
I NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
j 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
i MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I
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 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 BUILDIN DEPA ENT. DEPARTMENT.
X OWNER X BY
DATE I DATE
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DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
rwprov
ed Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review W L tNg JN er&�& s
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit s .
Plan Check S d
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Feep
Other
Other
Building Valuation: y, �d TOTAL FEE g ,
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by
PLUMBING Attic by OTHER
Groundwork
date b date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date L/-13—I,,, by C date by
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