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HomeMy WebLinkAboutBLD93-1135 Garage - BLD Application - 7/21/1993i !.) P,er it No. . ` MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5Wt 2 1993 PLEASE PRINT #1 Owner ALyy Je11?!' Ji SS;'LT/S Phone# - ' - Site Address e-'4Aleg Fire District#J City '1�40 e St tUA Zip ?ISL 1 Directions to Job Site /(e�X 3 yzp ✓ A, fi¢ir�� LEST 6/u Ica !!mac 5!!f, 4rF7-diy 4J, _s-146ePF-- AE' , oA) - WAIV /Vicc 16 '44s7- AGiso.�J LI�N� ��P��°0'X �Do Fr Lad, Gene cs�r� wf/� �.4=s y/3u�c T sici✓ oo+./ Owner Mailing Address 76 City G/ !!P sNW W St wj�'- Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name )59;9 Y Balelr 15 ysr4w 1/C/C Contractor Reg# Address Expiration Date City ,4. St _Zip r Phone #3 If septic is located on project site, include records. Connect to Septic?__,&�/ Public Water Supply Well Connect to Sewer System? A/D Name of System (If residential, proof of potable water is required) #4 Parcel No 1�2�1 - 7�r - D©/ Legal Description Z-Z 1-/3 m f' &,4� 7/� ©oc- S ,13 V 7 #5 Building Square Footage: (existi /proposed) 1st FI / 2nd FI 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage Carport / (Circle:Attache or Detached? Other sq. ft. / #6 Use of building �i� � s/j- c'� �,grA41C jrrC Describe work #7 Type of Job: New Add Alt Repair Other #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: Aj4 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 ��Ss2 1 Plumbing Fixtures ($3 each *111e PA ) Mechanical Fixtures ($6 each No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other Bath Tubs No. Units 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- 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 OFTHE 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 OBTAINI PPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT X OWNER X BY ` DATE DATE FOR OFFICIAL USE ONLY: Accepted by: Date` `� l DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: 1/13/1) D3 Environmental Health: Building Plan Review jjj Occupancy Group: hl -.J- Type of Const: Fire Marshal: Other: Special Conditions: f t 2 �/'C>-. 5Ai'=C:S FEES �-� P-0or LOAD - Building Permit .(Z Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Building Valuation: 13, 00 TOTAL FEE (p �/Y J ...-� "► mac. 2) =zy. ' �.��► a N �h/ h w W I Jam+0/7 y 73M.�