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HomeMy WebLinkAboutBLD93-1395 GARAGE - BLD Application - 9/1/1993 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 L\,. \ #1 Owner Phone# Site Address Fire District# k� City © St Zip O�. 4 Directions to Job Site Owner MaUii g Address p. City St Zip Lien/Title Ho der NA Address City St Zip #2 Contractor N ime — ontractor Reg# Address ` Expiration Date ? / s /� City St Zip L4 7W_ Phone # E im-(o1 -77& #3 If septic is to ated on project site, include records. Connect to eptic? Public Water Supply Well Connect to ewer System?hC,Name of System (If residentia, proof of potable water is required) II #4 Parcel No. -�L- Legal Descri Lion #5 Building Squ re Footage: (existing/proposed) 1st FI / 2nd Fl / 3rd Fl / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / 2/GD Carport / (Circle: Attached or Detached?) Other sq. ft. / #6 Use of buildi ig I Describe work C' ��;�i L`-r 3 � #7 Type of Job: New_ Add Alt Repair Other #8 MOBILE/MA UFACTURED HOME INFORMATION Model Year Make Model Length Width Serial No. # Bedrooms # Bathrooms Type of Heat Purchase Price$ #9 Indicate by irclin ,th licable source if any water is on or adjacent to subject property: .......... River Pond Creek Strea 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) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW lam' �rom � CG.1�l-Cei6' cLc- \ k C \c)c;,� APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW E!jjmbino Fl: reach) Fig Mechanical Fixtures ($6 each) No. Toile s CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs NQ UniIs Fees Sho ers Furn BTU HotWater Htr _f Heatpumps Laun fry Washer Vent Systems Sink Spot Vent Fans Floo Drains Boilers/Compressors Laun fry Basins HP Dish asher Air Handling Units Disposal cfm# Urin Is Fire Protection Systems Othe Auto. Fire Alarm Sys 5000 Fixed Fire Supp. Sys 50.00 Permit B tsic Fee 15.00 Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ IQ Other Gas Outlets f— Wood, Gas, Pellet Stove NOTICE: THIS PEI MIT BECOMES NULL AND VOID IF WORK OR CONSTI UCTION AUTHORIZED IS NOT COM- MENCED WITHIN 1 0 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENI ED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF F CONTINUATION OF WORK IS BY MEANS OF A PRO RESS INSPECTION. OWNERS AFFIDA T CONTRACTORS AFFIDAVIT I CERTIFY THAT I M EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE C NTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND A I AWARE OF THE MASON COUNTY AMAWAREOFTHEORDINANCE REQUIREMENTS REGU- ORDINANCE REQI IREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED ANI THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE T IEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT F RST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEH ARTMENT. DEPARTMENT. X OWNER X ≥ vj �' -LLy DATE DATE '._ / —q FOR OFFICIAL USE ONLY:Accepted by: Date:' DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: ^^C Environmental Health: Building Plan Review RrLI pc R- i'J r f eL S ) 2t3L1,: Occupancy Group: /Y1 Type of Const: `�tJ Fire Marshal: Other: Special Conditions: FEES Building Permit j �f 7 Plan Check 7 y. Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee -5 Other Other Building Valuation: TOTAL FEE S`5 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 Improver ents Easements Indicate Directional by (N, S, E, W) Name of Flanking S reet in relation to plot plan Name of Fronting Street APPLICANTTODF W SITE PLAN BELOW cck l �J\ D APPLICANT TO DR W TOPOGRAPHY PROFILE BELOW i