HomeMy WebLinkAboutBLD95-1294 Cancelled ATF Garage with Living Conditions - BLD Application - 9/7/1995 Permit No.
MASON COUNTY �10
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRIN n p 1,
#1 caner �� clo / ' 4 J/cxr; n VhN DOR- � / 3 2
t Phone# 6o) 7S- 7V606
Site Address : H i I l -1?d Fire District# 2-
city 1�e �a;r St (A) C, Zip_ Q8 S Z 8
Directions to Job Site Ale r f k ®.. Nw "fa rn /e 44 a+ 30 0 /{1/e x+ fr�aI:,�l�t.
0 Old Be( u r r O 0� )4 C Hi /(('1k / P
Ga .VCr�ill driV� { or3 n �I� on C t Cd7 o du
IZo<Q 1, art left. T", 1e�+. I drivaw•v eK hlf is C21 to-mit RJ,
Owner Mailing Address o;Z l A!c` !1; /1 TRd
City -13 e Wai r St 0 g Zip 9aJ 2 8
Lien/Title Holder aAci2( s C. r p
Address P 4 7 S 14
Clty SfN 4n St K Zi 'Z6S- cals-
#2 Contractor Name Contractor Rq#
Address Expiration ,��(
City St Zip Phone,#
ITS co
#3 If septic is located on project site, include records. X
Connect to Septic?-Yf-5_Public Water Supply e C Well N14 < QiR
Connect to Sewer System?__A/0 Name of System 0
If re idential, proof of potable water is required) M
Parcel No. 12 3
3-zo - (o - 09 o c
Legal Description
#5 Building Square Footage: (existing/proposed) 11
1st FI / 2nd FI fily / 3rd FI / Loft /
Basement / Deck / #bedrooms / / #bathrooms /
Garage 1k8 / Carport / (Circle:Attached or Detached?)
Other d- ^sq. ft. 224 / G- c b► 1- ' 1qao 5
#6 Use of building t 61 Describe work
CAS LT-9 4,t TUA wcw n a --bcp u5o
#7 Type of Job: New Add Alt _Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial
#Bedrooms # Bathroo Type of He t
Purchase Price $
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property: 1 1
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences w
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements S
Indicate Directional by (N, S, E, W)
Name of Flanking Street
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
Ssefi•„ Z� $scfi.n Zo
Garage
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ySy,46'
Sea A-4a cA e_J
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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MAYOE McRr
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Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each
No. Toilets CIRCLE FUEL TYPE: Gas Electric
_Bath Basins Heatpump Oth icJved 9f-'e-
_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 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
oo 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 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 DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: �m5
Environmental Health:
Building Plan Review
Occupancy Group: Type of Const:
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
' • LUMBER SUPP
& WAREHOUSE CO ,
535 ELLIOT AVE. W. • SEATTLE, WASH. 98119
PHONE: 284,f530
TOLL FREE ORDER NO. 1-80q 562-2865. SHINGTON ONLY)
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WHOLESALE DISTRIBUTORS LUMBER & BUILDING MATERIALS
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JUL 2 ,. 1994
HEALTH
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