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Home My WebLink AboutBLD94-01500 Cancelled Bedroom and Den - BLD Application - 1/11/1996 Permit No. MASON COUNTY a BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner Phone##"1S - 0 9 I O •. r L�4 n E A Fire District# Address / ��il City St I'Vig Zip Directions to Job Siteqovizj aav Owner Mailing Address L�GI M/S4n1 Sly City g fineejokx St Uk _Zip ?6J/& Lien/Title Holder Address Clty St Zip #2 Contractor Name Contractor Reg # Address Expiration Date / / City &C Ch'Kt 4-*-\ St (4AJ_ _Zip $3k�L Phone# &M-49/O #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well � Connect to Sewer System? Name of System oal�L � 8��—C( — (If residential, proof of potable water is required) #4 /acelr No. -3 D 3 0 - _- D / Legal Description - �U—" D-1 L7 #5 Building Square F otage: (existing/proposed) 1st FI�/4is, ,rd2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building 1G c Describe work � � D #7 Type of Job: New _Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make Model Length idt Serial No. CFP C # Bedrooms Ba hrooms Type of Heat GENERAL SERVICES Purchase Price $ #9 Indicate by circli g ft applicable source if any water is on or adjacent to subject property: River P d Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other I i 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 APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW I Plumbing Fixtures ($3 eachl Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No Units Fees Showers Furn BTU of Water Htr Heatpumps Laun Washer _ Vent Systems _Sinks Spot Vent Fans Floor Drains / No. Boilers/Compressors _Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal _ cfm# Urinals hLQ, 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 PLUMBI G $ N4. r 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 ONE WILL BE IN CONFORMANCE CONFORMANCE TH�REWITH. NO CHANGES SHALL BE THEREWITH. NO HANGES SHALL BE MADE WITHOUT MADE WITHOUT FI ST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FIR M THE BUILDING THE BUILDING ARTMENT. DEPAT T X OWNER i X BY: DATE O DATE i FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review (dC%- Occupancy Group: fz-3 Type of Const: SN Fire Marshal: Other: Special Conditions: FEES Building Permit cNArJ6`- d usf 2 0 Plan Check I(z HIZ Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee . Other Other Building Valuation: TOTAL FEE 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 JANUARY 8, 1996 RE: PERMIT # 13L�`' 4 — DEAR _V0 P O Ot c C)I'll C I f C'- ON 0 /�� /�, 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 CANCELED. 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 DEPARr.n Li 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 $ _. V,. ONCE RECEIVED, KE 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 JANUARY 22 , 1996 . SINCERELY, KATHLEEN SOINE BUILDING DEPARTMENT (306 -427 -9670) EX 354