HomeMy WebLinkAboutBLD95-0562 Cancelled Deck - BLD Permit / Conditions - 5/1/1995 �0 Vermit No. C1 d 6u r�
ASON CO TY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT D
#1 Owner. Le YV 9a1,C E Phone#
i e Address(f/3Z/O . Fire District#
City 4a,#, yeS�zB St Zip 9y 9-
Directions to Job Site A Bocf-T )e-OC/,2 616C&S .OD,t>A) >�E m4Z,;
7,1Y,, J l'/A)
-T � 7 - T IS r,,�--
Owner Mailing Address--Aar 60"r ' /oS9
City L•V/.p . Zt/,4- St Zip 9k5 2 Sl
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name AAD/2Tii 1LII r/,D 7-7DA) Contractor Reg#N0A7' iGk,--07/J 8'
Address -71�3 �' i2�iy� SST. Expiration Date
City ,4,27- diQCAW/10 St 1,icW _Zip Phone#
#3 If septic is located on project site, include records. D
Connect to Septic?/t)& Public Water Supply Well Y v
Connect to Sewer System? A)O Name of System
�a
(If residential, proof of potable water is required) 8 V
195
#4 o./,�3.ZI - 33 /cam tS
VI scription S.A/• /l o'c- .S'
#5 Building Square Footage: (existing/proposed)
rVX
1st FIB/ 2nd FI /�• / 3rd FI ti 4 / Loft/
Basement A-1 /t / Deck %- (/ #bedrooms / #bathrooms /
Garagef3 / Carport ti'r3 / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building k""T""Pu Cc JtM ky 2,WfcAbe work
#7 Type of Job: New Add Alt _Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year )97 Make Model
Length g/ Width Serial No.
# Bedrooms # 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 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
M IF
APPLICANT TO DRAW TOPOGRAPHY PROFILE B W
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump., Other
Units Fees
A—Showe Fu rn BTU
_ o ater eatpumps
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
P it Basic Fee 15.00 A Fire Sprink Sys 25.00
TOT LUMBING $ No. Other
Gas Outlet
Wood, Gas, Pel Stove
NOTICE: THIS PERMIT BECOMES NULL AND V
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR it 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 B� �
DATE DATE
FOR OFFICIAL USE ONLY:Accepted by: Date:'
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: NW)3
Environmental Health:
Building Plan Review ✓Y 0
C-n ( v 4 z 5 4 S
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit `2�j cro
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee S
Other
Other
Building Valuation: ( �Z ' TOTAL FEE (o .c9