HomeMy WebLinkAboutBLD96-0053 Void Garage - BLD Application - 1/10/1996 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Te irr v
� � Phone# Zob - 333,,fner
Address 5t�d� R A)L _ _ Fire District# !�
City oal!� r t St Lc% Zip Vd
Directions to Job Site Ga 14c. eLISAk,cv.t !2� t �US� Vi'//a a . �cwA 4,
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Owner Mailing Address /9/8 3Z
City eu J, n q V,o ti St &'h Zip 9��✓�-Sg//
Lien/Title HolderOtt.)A�c V
Address
Clty St Zip
#2 Contractor Name rAa,.f rc e k 06 Contractor Reg#3-#A k KB,eI o MCA
Address .(/- Z00 6al4S'Av w �� Expiration Date
Cityv�S�o.f St Wa Zip `jd�`�� Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply II 1
Connect to Sewer System? Name of System
(If residential, proof of potable water is required) J�
114re
el No.t-r�- 5 y - O �/
l Description )v -3, L-4- '2-6 OU�t:l �' I %
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage w0 / Carport / (Circle:Attached oKtetache
Other sq. ft. /
#6 Use of building ��va a,e_ Describe work
#7 Type of Job: New—v--,/ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Make Model
Length i Serial No.
# Bedrooms #Bathrooms Type of Heat
Purchase Price$
#9 Indicate by circling the applicable source if water is on or adjacent to subject property:
River Pond Creek Stream Wetlan Lak 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
�d
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
si 4-(-
I -I-el A I f5/�
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Uni s Fees
_Showers Furn BTU
_Hot Water H _ Heatpumps
_Laundry Basher _ Vent Systems/
_Sinks f Spot Vent Faris
Floor rains No. Boilers/Compressors
_Lau dry Basins HP
_Di hwasher No. Air Handling Units
sposal
� f #
rinals No. Ff P r ti n Systems_Other uto. 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. ;1 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 TOTAL MECHANICAL $
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 DATE
FOR OFFICIAL USE ONLY:Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health: S
Building Plan Review
I'24-l4
Occupancy Group: —YYI— Type of Const:
Fire Marshal: U
Other:
Special Conditions: FEES
Building Permit (pD •SO
Plan Check 2L�• O O
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: �F��O C -C) TOTAL FEE