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Home My WebLink AboutBLD95-0144 VOID SFR - BLD Application - 2/2/1995 Permit No. VCNj- MASON COUNTY BUILDING PERMIT APPLICATION �. 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 v��0�� PLEASE PRINT #1 Aw 10 r� Phone# ite Address ]AAA / Fire District#City St-zt& Zip kJN 5 Direction_ s to Job Si e l0 nn Owner I'lailing Address f City St Zip Lien/Title Holder V Address r I City St� —Zip #2 Contractor Name 1 Contractor Reg# Address — Expiration Date City St Zip Phone# #3 If septic is located on project site, include recor Connect to Septic?—Z—Public Water Supply Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 Parcel No.� Legal Description Q F_ n 0 9 X #5 Building Square Footage: (existing/proposed) 1 st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / # bathrooms / Garage / Carport / (Circle: Attached or Detached?) ` Other sq. ft. / �#6 Use of building D w0��owN M0 #7 Type of Job: New-1—/00" Add Alt Repair Other HEALTH SERVICES #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year MaketYlUf Mode laCe�20C� ,,0 Length t d WidtF Serial n f No. n� kj P� hu\`� �/ # Bedrooms_# Bathrooms _Type of Heat czly �U/L. Purchase Price$ � -- "Q„ r �D #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 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 BELOWe ,T S - - - �4Q o ►� Z I 41 I, ,? Q7 o l -n o o IAA � � o Z) . � a -3 -� tj ,g s 7 14 QQ' r S� Q APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW eK U1 ,1►a� �= fat- w��..��.� � �•,�� ,� � Q Plumbing Fixtures ($3 each F _Q Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins _ Heatpump, Other _Bath Tubs. No. UDita Fees Showers Furn BTU _Hot Watertr Heatpumps _Laundry Washer Vent Systems Sinks Spot Vent Fans _Floor Drains No. Boilers/Compressors Laund, y Basins HP _Dishwasher No. Air Handling Units _Disposal cfm# _Urinals No. Fire Protection Systems _Other Auto. Fire Alarm Sys %00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. QLh Q r 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 OF THE 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 - DATE r FOR OFFICIAL USE ONLY:Accepted by: d' f ' ' Date: r r DEPARTMENTAL REVIEW FOR OFFICE USE ONLY A roved Cond. Hold Approval Planning: Environmental Health: Building Plan Review �A) Ic EW Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit l0� Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee44 Other Other Building Valuation: TOTAL FEE 1� �� MASON COUNTY DEPARTMENT of GENERAL SERVICES Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton,Washington 98584 (206)427-9670 BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION JANUARY 4, 1996 RE: PERMIT # P-X-AA 5-0144 D EAR Y`r1 1 C,l�C 11 S ON u-3 THIS OFFICE APPROVED FOR ISSUANCE THE ABOVE PERMIT NUMBER. PURSUANT TO THE UNIFORM BUILDING CODE, SECTION 304, THIS PERMIT, ONCE APPROVED FOR ISSUANCE, MUST BE ISSUED WITHIN 180 DAYS TO STAY VALID. FAILURE TO PICK UP THE PERMIT WITHIN THE 180 DAY TIME FRAME WILL VOID THE PERMIT AND IT WILL BE NECESSARY FOR YOU TO RE-APPLY FOR THE PERMIT THUS, MEETING ALL NEW REVIEW REQUIREMENTS. FURTHER, THE UNIFORM BUILDING CODE, SECTION 304 ALLOWS FOR THE COLLECTION OF THE PLAN REVIEW FEE IF A PLAN REVIEW HAS BEEN PERFORMED AND THE PERMIT CANCELED. IN THE EVENT THAT YOU NO LONGER REQUIRE THE PERMIT OR CHOOSE O CANCEL THE PERMIT, THE PLAN REVIEW FEE DUE ON THIS PERMIT IS $ ._C�tp . THE CHECK OR MONEY ORDER SHOULD BE MADE PAYABLE TO THE MASON COUNTY TREASURER AND SUBMITTED TO THIS DEPARTMENT FOR PROCESSING. ONCE THE PLAN REVIEW FEE IS PAID, WE WILL RETURN THE PLANS TO YOU AND CANCEL THE PERMIT REQUEST. IF YOU WISH TO OBTAIN YOUR PERMIT NOW, THE AMOUNT DUE FOR YOUR BUILDING PERMIT IS $ 1 (-p �_. 7�0 ONCE RECEIVED, WE WILL ISSUE THE PERMIT, EITHER IN THE OFFICE OR WE CAN PROCESS THE ISSUANCE THROUGH THE MAIL. THE PERMIT WILL REMAIN VALID FOR A PERIOD OF 180 DAYS. AT THE END OF THIS 180 DAYS, AN INSPECTION WILL BE REQUIRED OR A ONE-TIME ONLY EXTENSION CAN BE GRANTED THROUGH LETTER REQUEST HOWEVER, ALL FUTURE EXTENSIONS MUST BE GRANTED BY PROGRESS INSPECTIONS. PLEASE RESPOND TO THIS NOTIFICATION PRIOR TO JANUARY 22, 1996 . SINCERELY, L-"__ KATHLEEN SOINE BUILDING DEPARTMENT (306-427 -9670) EX 354