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Home My WebLink AboutBLD94-0570 Cancelled SFR - BLD Permit / Conditions - 6/7/1995 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 V � #1 Owner John d Phone# a e-)0 "a75 - LICK(o Site Address Fire District#3 City St)_Zip q850-18 Directions to Job Site + cir,_ � 1^ Q G ...� Owner Mailin�g Address n, aasr City � � ----" St Lc.i A- Zip Lien/Title Holder -- I U Address 3-77 r q S_ -r'_►-4 Yl e I1 G City Lri n1r l) -� SA St W'4 Zip 041 Ai� #2 Contractor Name F1 F'1 a r-. i 1 Contractor Reg# AA r-T w(e C Address Expiration Date_' _/ ( /_q _ City St� Zip ajSb2a Phone# ';;66 97 r0 #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) #4 Parcel No. Fa3�o Legal Description � /'6 Lea3 d �S e'' O fS Pc1��-'- 113) recorcls n 01Q,sor� Cour+y #5 Building Square Footage: (existing/proposed) 1st FI 14 /_ SCE FT2nd FI 3rd FI ----; Loft / Basement- 1- Deck 1 S Z—/_-:Q -FT #bedrooms / #bathrooms_/ Garage -10 C> / Sc F7 Carport i (Circl Attached r Detached?) Other sq.ft. / #6 Use of building a5•l clenDiA L Describe work C171V STtZv1 LT 'VJPCPQ Fr2A4M f SI V1(rA E F61M I L-Y R-E S 10EdC2. #7 Type of Job: New _Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION flESPHYED Model Year Make Model APR 2 b 1994 Length Width Serial No. #Bedrooms # Bathrooms Type of Heat GENERAL SERVICES 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 ►` �� ppppp— 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 y N, , E, W Indicate Directional b S Name of Flanking Street ) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW - N 10 MIA { : i ( I J I 2ESt2�F— W t? ,, AXEe APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW i> Plumbing Fixtures ($3 eachl Fee Mechanical Fixtures ($6 each) No.21Toilets CIRCLE FUEL TYPE: Ga Electric Bath Basins Heatpump, Other — _.2_Bath Tubs No. Units Fees _Showers Furn BTU _LHot Water Htr �, _ Heatpumps �y �i Laundry Washer ./ Vent Systems Sinks Spot Vent Fans _Floor Drains No. Boilers/Compressors QLaundry Basins HP Dishwasher No. Air Handling Units Disposal _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 $ `i . 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 DEP MENT. DEPARTMENT. X OWN X BY DATE 0 DATE O FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: 1111'T' Environmental Health: Building Plan Review an,.P cbAti Occupancy Group: 2 "5 Type of Const�— Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check C Plumbing Fee (D Mechanical Fee Ob Wood/Gas/Pellet Stove �5,(f) Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Building Valuation: TOTAL FEE r7 MASON COUNTY DEPARTMENT of GENERAL SERVICES Mason County Bldg. III 426 W.Cedar P.O. Box 186 Shelton,Washington 98584 (360)427-9670 BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION March 6, 1995 RE: Permit # a Dear On U /\bfkLk , this office approved for issuance the above permit number. Pursuant to the Uniform Building Code, Section 304, this permit, once approved for issuance, must be issued within 180 days to stay valid. Failure to pick up the permit within the 180 day time frame will void the permit and it will be necessary for you to re-apply for the permit thus, meeting all new review ' requirements . Further, the Uniform Building Code, section 304 allows for the collection of the plan review fee if a plan review has been performed and the permit cancelled. In the event that you no longer require the permit or choose to cancel the permit, the plan review fee due on this permit is $ The check or money order should be made payable to the Mason County Treasurer and submitted to this department for processing. Once the plan review fee is paid, we will return the plans to you and cancel the permit request. If you wish to obtain your permit now, the amount due for your building permit is $ .OCR. Once received, we will issue the permit, either in the office or we can process the issuance through the mail . --The permit will remain valid for a period of 180 days. At the end of this 180 days, an inspection will be required or a one-time only extension can be granted through letter request however, all future extensions must be granted by progress inspections . Please respond to this notification prior to April 7, 1995. incere Cheryl R gan t Building Depa ment (206) 427-9670 cc: Property File