HomeMy WebLinkAboutBLD95-0434 Cancelled Bridge - BLD Application - 5/27/1998 Permit No. - b4M-::
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 �We
dress 700 OLD BELFAIR HIGHWAY Fire District# 2
City BELFAIR St WA Zip 98 528
Directions to Job Site 1 /2 MILE SOUTH OF BEAR CREEK STORE, ON LEFT SIDE OF
OLD BELFAIR HIGHWAY
Owner Mailing Address 3706 KENNEDY DRIVE
City RR FMFR TON St WA Zip 98 312
Lien/Title Holder VICTOR R. SEAMANS
Address 3706 KFNNFDY DRTVF
City BREMERTON St WA Zip 98312
#2 Contractor Name VIC' S QUALITY CONSTRUCTION Contractor Reg#VICSQCIO95LL
Address 3 7 0 6 K ENN EDY DRIVE Expiration Date 03 / 31 / 9 5
City BREMERTON St WA Zip 98312 Phone# (206) 377-6968
#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 cel No.1 231 6 - 50 o
6rj� egal Description FT T T S BANCROFT TRACT �- rI U
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building BRIDGE AND ROAD Describe w
AW
r 3
#7 Type of Job: New X Add Alt Repair Other —"� D
#8 MOBILE/MANUFACTURED HOME INFORMATION M
Model Year Make Model X
Length Width Serial No. _<
# Bedrooms # Bathrooms Type of Heat 0
Purchase Price$ C Q
#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 BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
��i f
Plumbing Fixtures ($3 eachl Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
_Bath Tubs nib
Sh ers Furn BTU
Hot W er Htr _ Heatpumps
_Laundry Washer _ ent Systems
Sinks _ Sp t Vent Fans
Floor Drains � Boilers/Compressors
_Laundry Basins HP
Dishwasher No. Air Handling Units
_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 BUILDIN�Gjl✓P � T /� DEPARTMENT.
tDTE
WNER (( ��%►�� X BY
s l� DATE
FOR OFFICIAL USE ONLY: Accepted by: Date: j
i
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review
Occupancy Group: Type of onst-,"**\�s
Fire Marshal:
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
Other
Other
Building Valuation: TOTAL FEE