HomeMy WebLinkAboutBLD93-0787 - BLD Application - 11/16/1992 ?exit No.3L
MASON COUNTY -
BUILDING PERMIT APPLICATION
ptEASE PRSNT
0
#1 owner `!teem �LiE-�- ?hone#
Site Address- E 13Z. 6cae noove
City
Directions to Job Site �o� �
- �-
Owner Mailing Address �-
City. St &/,ram Zip
Lien/Title H lder _ �i�sT /l',�,Ct��..4'c � - ��x�'
Address �0, 6 a& y
City, o�7`- /�N�L� � st _l.�i+- zip 3�
#Z Contractor game ,rim Coat_ractor Reg#
Address E=iration date_
City St Zip Phone
#3 If septic is located an project site, include records.
Connect to Septic? Public Water Supply__ Well
(If residential, proof of potable water �may be required)
*►4 Parcel No S /1- e
regal Desc:i tion rs / T
P 5� 2 Olt l,/���s fly
#5 Building Square Footage: e�dsuaq 8ed)
1st FI 2nd FI 3rd FI / Loft
Garage—
/ Deck / #bedrooms _ #bathrooms
G I Carport (Circle: Attached or Deta
- / ched
Other sq ft /
.l
#b Use of building 'ej
Describe work T
ell- ex 0
# Type of job: New _ Add Alc
Repair Demolition
Woodstove_ Re-Roof Bulkhead_ Other
n8 MOBILZ HCMy rNF0RM TT-0m
Model Year 1! e .ei�J ; Cd
---- ��` `' Mode_ / '�"telc m066E6
Length_3= Widt:i�_ Serial No . tl_- )IJJ 7 --'
RBedraoms ./ #Bactrooms ,!' Tyne of Neat s4 S
T9 Any water on or adjacent cc prone=cy: salcwac_=_ Lake /t4"
i.VA"' '1nTn
($2 eactl- - -- - ' --
'No . ecs` vent Systems X 3 . 00 -`
Sac 3asi..s Z,Vent: cans X 3 .00 _
Baths — No. Boil ers/Cammpressors
_ I Showers
-- 0-3 RP �_
/Rot Wacer at_ 3-15 3P 5. 00
Laund. r Washer
,5-3 0 HIP 5 .9.2.
_+.—.._ 3 0-5 0 HP . 5 . 00
?104� wins
_, 50 + HP 6 . 00
_
Lam Basins No. Air Handling Unit
Dishwasher
Disposal. —> 10000 clm. 7. 50_
_Uriaals OttUw
_Qtyer IN Coolers _
Roods _
Pewit Basic Pee 3 . 0,0 Fire Suppression _
TOTAL � S -__;.Domes. Inci,n.
Ca=l. Inc n.
Reloc/Repair 6.00
Mechanical Fixt�,res I,Gas Outlets X 2.00
NO. Feel Types Woodstove se_
-Z—Furm < 100R BTU - 6. 00_ Other
Furs >-- I00g BTQ _
_ Fu= - Floor 6. 00_ Pewit Basic Fee 10 .00
_Heat Pis _._6- 00 TOTAL MECMtICAL $—
NOTICE: TT32S PER,,= BECOMES NULL AND VOID IF WORE OR CONSTRUCTION
ADTSOR,r I3 NOT mom® WITHIN Is0 DAYS. OR ZF CONSTRUCTION OR WORK
ZS SUSBENDED OR ABANDONED FOR A PERIOD OF I80 DAYS AT ANYTM-M AFTER WORX
IS CO�N�
oKMMS Arr=v= AFr=vrr
I CEM"PT THAT I AM OCEwT FM THE MMIREMENTS or THE t CERTIFY MAT I AN A aMtREIfTLT IMSTERE® ComGC=
CCOTRACTORS REG:STRATt01 uY 00 ta.V , AM AN AWRE M THE STATE aR WLSMINGT01 AM I AN AWRE OF THE
Of THE MAC =a1TT ORDINANCE eEaIIRemis FOR WNICR ORDINAMM RMIREMENTS REGULATING THE WORK FOR WNICN
TNIS PU"tT IS (SSIIED AN* THAT ALL WIM 001E WILL M IN THE FGENtT IS ISSITED All ALL wQK OO+E WILL eE IN
WI TNCRMANrInn TN. NO OAL A SNAIL eE RACE CDNPMmh.E TNERtV{TR. NO CRAM MS SNAIL 8E NAOE
WITNWT f{RST TA(NfMG M►RpYAI fR01 T1N< dltllplMC WtTNORT FIRST DETAINING APPWMAI FRM THE MILONG
OElaARTl1ENT. '
DEPARTMENT.
Z BT
t1Ar t]AZ�
Retisr� permit to : Depart=ent at General Sex-rites 426 X. Cedar/p.Q_ Box 186, Shelton, WA 98584 427-9670/1-800-562-5629
paR aF"TC+.ZL IISa ONLY: Accemr-ed bv: v .
Oar-
Show following on the site plan
Loc Dimensions Flood Zones
E istiag Structures Fences
St:scturs Ser.Sacks Driveways
water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Smflrovements Easements
Name of Flanking St_=eet Scale:
Name of Fronting Street Dace:
PLiCAM TO DRAW SITE PLAN ;wT,011
I
M
IPLIC:;= TO DRAW TOPOGRAPHY PROFILE H
I'
DEPART lEiNTA,L REVIEW
Folz aFFIc$ =z ABLY
z -
Aoorowd card Meld
Aporw4al
Planai�q: Dl�
Ea�rO�eata.l. 8ed1�:
Boil q Play view: S
Occupancy Group
-
Fare D�ars�.all:
atiier:
IISPeGia . Conditions: II Site --- '
II Iaspectioa I 3
II �
Il it gidt�g Perazic I
II "
II II lviciatioa Fee I II
II Iif
II II Ilvioiacion Investigation Fee I II
II it II I
II If IlPlan check I Il
II II I I
II II Il Pluasb:Lng- Fee ( II
II II II
II II IIMectanicai Fee I II
II II IF--
---------- II Ilwvadscove Fee I II
II II I .I
II IIBui?ding Stace Fee I II
.I I
_Valuac:on: