HomeMy WebLinkAboutBLD94-1583 - BLD Permit / Conditions - 10/17/1994 Permit No.
II�IASON (BOUNTY
OCT 1 7 19% BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 00
PLEASE PRINT �✓� ��f�L .. ,
#1 PTH11
�(� �% �1 K)6 Phone#ess �� �C3� �St�{T�IJ Aj�ZPDI�T" �l t� Fire District#
City St��Zip
Directions to Job Site 'k 0 "b ti ei 0Z:1r ►�-
Q M1 L-e-`' 6KN i_�-r
Owner Mailing Address E A-S
City St Zip
Lien/Title Holder �G`1L Arta iZ
Address -•t-
City 's �--Tor4 St == Zip
#2 Contractor Name L—�P Contractor Reg#
Address Expiration Date
City St Zip Phone#
-70 '�kic-
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#3 If septic is located on project site, include records. -7 0,
Connect to Septic? Public Water Supply Wel INK.
Connect to Sewer System? Name of System
(If residerpt al, proof of potable water is required)
#4 �gcaIeI No. 00-L Description
#5 Building Square Footage: (existing/proposed)
1 st FI (a-7a / PT-- 2nd A / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms ( /
Garage / Carport / (Circle: Attached or Detached?)
Other sq.ft. /
#6 Use of building Q i r��� L�'1 QV—' ) Describe work
am,NA*a-c 1 �w�. y. `t - �J,
#7 Type of Job: New V Add Alt Repair Other
#8 MOBILE/MANUFACTURED ELOME INFORMATION
Model Year Mal e= " "Model
Length 419' Width 11+ Serial No.0 Q 3�3
# Bedrooms # Bathrooms i Type of Heat J�l&-e_.
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 �1
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 Indicate Directional b N, S, E, W
Name of Flanking Street in relation t p
y lot Ian )
Name of Fronting Street p
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
C y ��
I
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Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No._T,pilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Units Fees
_Showers Furn BTU
_Hot Water Htr _ Heatpumps
_Laundry Washer Vent systems
_Sinks _ /Spot Vent Fans
_Floor Drains No. ,1 Boilers/Compressors
_Laundry Basins HP
_Dishwasher \Auto
Air Handling Units
_Disposal cfm#
Urinals Fire Protection Systems
Other Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 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.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
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 BUILDING DEPARTMENT. DEPARTMENT.
X OWNER ��' X BY
DATE l y_ r� — I''-1' DATE
FCta OFF
at,
USE ONLY:Aceptec by. Date::
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: ID13
Environmental Health:
Building Plan Review
Occupancy Group: Type of Const:
Fire Marshal:
It fat
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee y
Other
Other
Building Valuation: TOTAL FEE
03
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