HomeMy WebLinkAboutBLD95-0850 Cancelled Deck - BLD Permit / Conditions - 11/1/1994 Permit No.
05.1 0
MASON COUNTY 6 b
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner �y ti,�, L[�"Lr /!fiz) t, N Phone
Site Address tQ C- / Fire District#
City Bit,F--A 4t �,9 St Zip
Directions to Job Site r,,.,e-1r o v r cam'= 3E-c-�r% ) . MI ut
yC�ir ICIW f c,,-J LC. ,1 i I`ni L.lr t_-L5-1-7' 1 rV7u f3Z.T'54 X /`-l- O✓L.
/ S-t- l2-r Gim-ram a r4 GZ-k, H,LL. ?a 470 (-fir o N !r`-ION .fir Qrl
Owner Mailing Address 1ZLI /"7'2, ►-
City ` RGr LLQ1/QW 4- St Zip 9r0�7
Lien/Title Holder =--
Address O
Clty Zip
#2 Contractor Name Contractor Reg
Address xpiraJ H.
/
City - St Zip Phone
#3 If septic is located on project site, include records. u� O
Connect to Septic?_ytZ_Public Water Supply Well
Connect to Sewer System? Name of System n
(If residential, proof of potable water is required) t)
#4 Parcel No. - 50
Legal Description r—L, vL �► 9-n•���— T2�04
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / # bedrooms / #bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other Di XJ CG sq. ft.
#6 Use of building c-er,—( Tp v,-,c 0$ u u- hffl r"c,— 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 4f 14-4
Purchase`Pric'e $
#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
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
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APPLICANT TO DRAW TOPOGRAPHY PROFIL
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Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
B h Basins Heatpump, Other
Bath ubs Units Fees
_Showers _ Furn BTU
_Hot Water F _ Heatpumps
_Laundry Washer Vent Systems
Sinks _ Spot Vent Fans
_Floor Drains No.", Boilers/Compressors
_Laundry Basins _ HP
_Dishwasher No.. �ir H n linUnits
_Disposal _ cf�o
Urinals No.. Fire rotection Systems
Other _ Auto. ire Alarm Sys 50.00
Fixed Fi Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire S ink 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 OBTAINING APPROVAL FROM THE BUILDING
THE BUILDIN DEPARTM2 DEPARTMENT.
X OWNE X BY
DATE ZZ . DATE
FOR OFFICIAL USE ONLY Accepted by3te
—�
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DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
6/Z6
Environmental Health:
1 21-�s
Building Plan Review . C�
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check Se
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
� c o
Other
Building Valuation: TOTAL FEE