HomeMy WebLinkAboutBLD95-0403 Garage - BLD Application - 3/27/1995 '�� O� Permit No. " AP
MASON COUNTY �O p/
BUILDING PERMIT APPLICATION _ o�
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 0.�,�ba
PLEASE PRINT 1
#1 Own � A-� ylA.��// Phone# 2yL: - 7Sa - 3 5�`1
e Address L 7991 f-�� [�/� Fire District# to
Cilty (J17 i O✓1 .St 4/f� zip-
Directions
Directions to Job Site 30 ` iriro m,/e t-7 L "g ��5/If
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Owner Mailing Address 3(. O S v,4 .cJ 7-oAl
City �'9'cU�1� St V/f- Zip ?I?tl o 2
Lien/Title Holder t4-&
Address
City St Zip
#2 Contractor Name Contractor Reg #
Address C C' 7lJ — /cam Expiration Date
City ,5 H6G.7T0 "t') St c✓A— Phone
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
4 egal Description !(-ct C /Z rt,, Gov Lpt 3 bole-K7h01
#5 Building Square Footage: (existing/proposed)
Ost FI '720 / 2nd FI 7 20 / 3rd FI / Loft /
Basement / Deck / #bedrooms / # bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other sq. ft. /
#6 Use of building 4-K 46 C Describe-rk
S 31
#7 Type of Job: New__Add Alt Repair Other N
W
#9 MOBILE/MANUFACTURED HOME INFORMATION m C=
X) to
Model Year Make Model C c�71
Length Width Serial No. 5
#fir om� s # Bathrooms Type of Heat
--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 altwater 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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets 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. Boilers/Compressors
_Laundry Basins _ HP
Dishwasher No. Air Handling
_Disposal cfm#
Urinals No. Fire Protection Systems
Other _ Auto. Fire Alarm Sys 50�00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto 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-
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
FOR OFFICIAL USE ONLY: Accepted by. Dater
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: /�Z",JL ' ✓L I le
&4G6
01
""CAL
Environmental Health:
� QN
Building Plan Review
3-9�
Y 2 it
Occupancy Group---� l- I Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check S (t _S b
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
c�
Building Valuation: IZ g C7 TOTAL FEE