HomeMy WebLinkAboutBLD94-1584 Cover Over Delivery Truck Dock - BLD Application - 10/18/1994 MEMMOTRM
U� � �ru= l4k,r[� Permit No.
MASON
COUNTY
OCT 18 04 BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
L 'rJ
#1 Fite
Keith Uddenberg,Inc. Phone# (206) 851-6688
dress N, 04'5 `.h!-�i t� o_v f F QU Fire District#
City -F"e-,9/A St _Zip
Directions to Job Site
Owner Mailing Address P • O. Box 444
City Gig Harbor St WA Zip98335
Lien/Title Holder im
Address
Clty St Zip
Keith Uddenber Inc. EITHUI166OA
#2 Contractor Name g► Contractor Reg#K-��
Address p_ n Box 444 Expiration Date 09 / 01 / 9 5
City Gig Harbor St WA Zip 98335 Phone# (206) 851-6688
#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)
#4KPcell'No.�- -�escription Tract NE NW 29-23-1 #12329-42-00190 and Tract 22 of NW SE
29-42-00220.
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other (�Q_✓40l o%e.i2 an/1 veer✓ sq. ft.
7enCK Dock
#6 Use of building /la ul ka n nyyarze ;I Describe work.
A,&n ?-Rti0e 11"j? 1 t1AC�&,ek SV-AA)d 20,9111
#7 Type of Job: New Add Alt Repair OtherZ &s/ter 7�)
v v c de,
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
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
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
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. uaila 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
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- TOTAL MECHANICAL $
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
FO OFFICI L U3E ONLY: Accepted byL,� Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review
A�
Occupancy Group:_—Z Type of Const:
- 1
Fire Marshal: 0
10
Other:
Special Conditions: FEES
Building Permit
Plan Check 451
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee A_-
Other
Other
Building Valuation: 2- JJL TOTAL FEE Z 3 Z