HomeMy WebLinkAboutBLD93-0611 Partition Walls - BLD Application - 5/7/1993i -, Permit N9.
MASON COUNTY C�
BUILDING PERMIT APPLICATION °
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
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Site Address �' Od Fire District#
City �J�L F�/R W St %L Zip
Directions to Job Site f i^ C%K e-o^ AeA,
Owner Mailing Address _ - Sou 3747
City /7,�Lft/�c try St Zip r4tf-?tf-
Lien/Title Holder l 4* 0���
Address �i�'��•�/I�
Clty l 't St •'— Zip fyX-3t* '-'
#2 Contractor Name J�L Contractor Reg#
Address Expiration Date
City St Zip 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 Parcel No.1 i� -��
Legal Description s,�G Td h-/�f-41e /V• t �"��f 7
#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 ew��li�Rjc%�� 0/c/ri Describe workll�l`l�
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#7 Type of Job: New Add Alt Repair Other
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#8 MOBILE/MANUFACTURED HOME INFORMATION 4oL 40�eis%/^= XcwA j fxx )0,4L
Model Year Make Model a� ,E0p
Length 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
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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 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
I
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
- J
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
4ath Basins Heatpump, Other
Ba \\Tubs No. Unk Fees
Showers / Furn BTU
_Hot Watbr Htr Heatpumps
—Laundry Washer _ Vent Systems
—Sinks — Spot Vent Fans
Floor Drain No. Boilers/Compressors
—Laundry asins HP
—Dishwasher \ No. Air Handling Units
_Disposal _ cfm#
_JJrinals 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 J
7 DATE
FOR OFFICIAL USE ONLY:Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review
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Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check s
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE
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