HomeMy WebLinkAboutBLD95-0197 Cancelled Greenhouse - BLD Permit / Conditions - 9/20/1995 W
LC
� O I N
NO 49 CAD W .
1
". 145.69
i
�S7
� lb
S ki
.00 O�
NC �.
1
At,
r
N88003'00'tE 17451 _
33.04 70.07 71.40
00•i
570
BE
w
•
Op
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 b
PLEASE PRINT
€mot 4Zsz
#1 wn M I TC,(( �til_ ls�wl(3 C(?. C6 _Phone##
e Address ►�c �3 8 I �-}�t¢,�J io�-�E' �7 Fire District#. �
City gElrF/� tlZ_ _St w►`1- Zip f�S 3
Directions to Job Site N c-X 1- To 'B cLtz�t R Pos r o t'
LU
Ofer Mg Address 130 X 3 l 0
® Ci- LL1 -ice I li. St
�] Lie�/Title
AMess `,o M c_c_ R o• B�+X 3 ld
Clt. a C-t_.F:A t tZ. St L-L-W✓+ Zip 49rSd-Fs
Contracto me —Contractor Reg#
L�—J�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 resi ntial, proof of potable water is required)
#4 Par el No. S:3 ,- � - �' ®b 20 a5 6 5 S
egal Description 23� r ti���
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other 'i.s-e, sq.ft. / 710
#6 Use of building F11L.L f" �e 1S Describe work
#7 Type of Job: New Add ✓ P'60R Alt Repair Other ✓ tZ�r' TG—
#8 MOBILE/MANUFACTURED HOME INFO 616N
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 Pon Cre� 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
�lar�e-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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
i
I Plumbing Fixtures ($3 each) Foe Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Uni s Fees
Showers Furn U
Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Syste
Sinks _ Spot Ven ans
_Floor Drairl No. Boilers m re sors
_Laundry/Basins � _ HP
_DishyNasher- No. Air ndlin Uni
D16posal _ /Ire
#/Orinals � Protection S t
Other _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Other
Permit Basic Fee 15.00 Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ o..
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
}
Now=; _ ""' .......D ( (
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
(3
Planning:
Environmental Health:
Building Plan Review
Occupancy Group:OA Type of Cons
Fire Marshal:
Other:
FEES
Special Conditions:. , ,
Building Permit f(a
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 ' '