HomeMy WebLinkAboutBLD92-1159 cancelled - BLD Application Pezmit No.BLD
MASON COUNTY
BUILDING PERMIT APPLICATION
"Im MINT
z�—
#1 Owner A�eJo2�� D. v Phone#
Site Address /.5/ = cre
City ref j >g St Zi 8 F3
°
Directions to Job Site 5 42 2- r
r_
Owner Mailing ss 0,jqoV 134A 54, ice, L VQ U
Ci tY .____,_S Zip 29.5-4L
Lien/Title Holde tylyrX
Address ?-
City �?i Dr- S Zip gg33-5
#2 Contractor Name s Contractor Reg#
Address Expiration date /
City Zip Phone
r �
I � #3 If septic is located project 'te include records.
e ! Connect to Sep ic? Publ er Supply Well____._.
(If residents r of otabl er may be required)
r �
#4 Parcel No. ¢z - yd
Legal Description o F v �o/.. /,3 /1 8� O
P ?
#5 Building Square Footage: (e3cul ia�roposed) 'l`� `� " 6 C, (+4
13t Fl/& ,027�/6(L2nd Fl A/ / A 3rd Pl jL / � Loft �
�
Basement /� Deck it/ / ,� #bedrooms El #bathrooms
Garage /lam/ d Carport Al^/ ,4 j (Circle: Attached or Detached?)
Other------- sq ft /
#6 Use of building /77i/7/ -570IZ19G E Describe work LW660 i 2 �
f #7 Type of Job: New �/Add Alt Repair Demolition
E Woodstove® Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length Width, Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater, lake
river pond- wetlandl}//Q seascnal nancf c
or_hP--
�� , mom; .,� ��•,-.oG r S2 each)
No. Toilets Ao
------ OCA Vent Systems X 3 . 00
Bath Basins Vent Fans X 3 . 00
Bath Tubs No. Boilers/co-- ozaPreasvrs
L -y 1 _Oct 'Rater ?qtr 0 3 S0 HP 0
aund_ washer -- -0
Sinks 0-50 HP -
F1oor Drains 50 + gp __5 - 0'
Laundry Basins � - No. Air --�Q-
-- -- Saadling Unit
Dishwasher <- 10000 cfm.
Disposal --�4-
._> 10000 cfm. __ 7, 50
Urinals Other
Other �_ wrap Coolers
_,Hoods
Permit Basic Fee ; 3 , M Fire Suppression --
TOTAL PLU1yIDING $ Domes. Incin.
-Coaxal. Incin.
r
Mechanj r-�t Reloc/Repair 6. 00
__ FiXttTrAq �` .r Gas Outlets X 2.00 Hi
No. Fuel Types Woodstove
_„F urn < 3.001C BTU -6.0 0 ¢, Other
®Furze >. 10 0 K BTU
—Furs - Floor ` 6•00- Fermat Basic Fee
Heat Pumps .00 �-
TOTAL DCBMANICAL
DtOTICg: THIS PfiRMIT BSCOMBS NULL, AND VOID IF WORK OR CONSTRIICTI N•
AU'I'SORIED Z IS NOT COMMR'NCED WITHIN 190 DAYS, OR IF CONSTRUCTION OR WO
IS SUSPENDED OR AHANDONED FOR A PERIOD OF 180 DAYS AT AN=2.fE AFTER WORD
IS COMMENC=
Ft
� � �
M°CWtFY THAT I AN 080, FROM TM REffiiIREMEM Op Tic
C=TB`WTM MISTRATtON LAY MU 1�� I COTtFY TMAT t All A BFTLT REGtSTE!® CofltAC
of TNt "' Mt ca ff" MI • ARo a AUARE IN THE STATE OF W MI 1112 I AM AN AWA Ci THE
TWIS PVMfT IS 1 ,, i O ANO ALL wMK OONE wjU I BE in OMINAMQ REG;itRB1EMV REG3ltATING ME YORK FON MIICR
CIONFORIIANCE rNVAUITX. NO HE T TNI PERIItT IS ISil1Ei} AND ALL � OOME WILL Bt IM
VtTNOIR FIR MF'RtTtKaL
ST OBTAINING Ci R " CINIFC VMM TNlREdM- NO CRAIICES SMALL Of M M
COARTMU. fR0! T BUtitLDIU MANE R YITNOIR FIRST OBTAINING APPIMIAL FROM THE BSIILOIMG
OE�ARTIIEI(T.
2 OWNER
Z SY
DATE 1
9
Return permit to: Department of Generaal Services
426 W. Cedar/p.0. Boat 186, Shelton, NA 98584 427-9670/1-800-562-5628
FOR OFFTCMAL USE ONLY: Accepted by: Date:
0
Show following oa 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
77
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT To DRAW SITE PLAN BELp
� ��¢ �p �h��� Z �.F � �� Can sf�u�•�-��-� ��
PLICANT TO DRAW TOPOGRAM P pnS
lever l
L
LLl tit\A LVJIjjN LtLL.1 r*jrj V ljr Yy
FOR OFFICE Um mmy
Appre"M Coed Noid
AppM"j
Planning: ;
Eavirc=ental Health:
Buildipq plan Rev3e+�:
v 0
�kL r+ e
Occupancy Group: ,
Fire Marshall:
Other:
i
US ecial Conditions: 11 Ilsite Inspection I
a it
11 a II IlBuilding Pe=i.t
II 160 n
II
- ll II pviolation Fee I j U
a t n
11 U SEP ' 4 tom 1 11 UViolation Investigation Fee I q
-GEREHAU
SERVI lI UPlan Check
11 t n
II 11 rt -,1
II Il ll Pluming Fee j it
II 11 I
11 - 11 UMechanical Fee ) q
. 11 1 1
II 11 IlWoodstove Fee ) )I
it II If---®— - —'I
11 11 IlBuildi.ng State-Fee ( ! II
I`— � '1 I I
11Huilding valuation: II II TOTAL0'1. �))