HomeMy WebLinkAboutBLD98-0343 Cancelled - BLD Application - 4/14/1998 P&red— Fl
Permit No.f�Lbgg'QM3
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
PLEASE PRINT
#1 Owner La�ry S A-fe e?r Phone# Jr 9'
Site Address !/DO N E' Z-qv Soh Ah,-d� Fire District#
city ezy, -z St
Directions to Job Site o /,91W /3c/�a,!^ UST /1/D�Tz S�nrc /i?o� / /�i/e To
/f on Scer,11 /h'i//�
�J d lenxJ o n
Owner Mailing Address /�j J�fJ. /12g ,.4o 9Ariv Za,,2 G
City ,S' ' Ze St zip 98'38'3
Lien/Title Holder
Address
Clty S Zip
#2 Contractor Name L� C UBI # Coo-O 6 0�T6
Address O f� Contract Reg # RL.I
City ,Bel&li- St G�/�Zip 8 Phone# ,275=�06/Expira nDate
#3 If septic is located on project site, include recor
RECEIVED
Connect to Septic? :/ Public Water Suppl Well
Connect to Sewer System? Namerof*stemAPR
(If residential, proof of potable water is re'' ired)
t ,
#4 Parcel No. / 33 D- ;Legal T—
Description L �' / O 1 Go e.
#5 Building Square Footage:
1 st FI Z 2nd FI 3rd FI Loft - Basement
# Bedrooms # bathroom ,Z Deck Other
Garage Carport (Circle: Attached or Detached?)
#6 Use of building dCn r� Describe work
/-�7oyC j 9'e F/cc Tu.-POW /`7o G,'/ To Lo T 11a
#7 Type of Job: New 1,� Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year IF `,-Z Make fi%e7vodModelf4reee1 �11
Length Width Serial No.
# Bedrooms 3 # Bathrooms X Type of Heat L�/etTr.0 9L (,�jOpc/,sTOvc
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 No/Ia
Show following on the site plan
Lot Dimensions Fences
Existing Structures Driveways W
Structure Setbacks Shorelines
Water Lines Topography
Drainage Plan Wells
Septic Systems Easements
Proposed Improvements S
Name of Side Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
90
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3.45 ea;.hj Fee Mechanical Fixtures ($7.00 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 17•25 — Auto Fire Sprink Sys 35.00
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 17.25
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 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 OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMFNT.
X OWNE X BY
DATE O l DATE �� U
FOR OFFICIAL USE ONLY: Accepted by: ' Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review /`/0 1 ',
Fi' L'Ult� . Tfre flirt / �e /aceoC a n ,�stvr �J"
0_-.50/_3 ��ao� .6SDc2Co SG 4/0 too
Occupancy Group. -0 Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit O�
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Violation Fee
Site Inspection
Building State Fee S�
Other
Other
Other
Building Valuation: TOTAL FEE
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