HomeMy WebLinkAboutBLD97-00995 Cancelled Remove and Replace Sheathing - BLD Application - 8/8/2002 a]NlPermit No. Ut
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
PLEASE PRINT
#1 r Tom and Sandy Swydecki Phone# 360 427 5086
j ite Address E 381 Dartmoor Drive Fire District# 5
City Shelton St WA Zip 98584
Directions to Job Site Highway 3 to Mason Lake Road. Right off of Mason Lake Road
onto Dartmoor Drive. Bear right on Dartmoor to E 381.
Owner Mailing Address Same as far as we know
City St Zip
Lien/Title Holder Information not available to contractor
Address
City St Zip
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#2 Contractor Name Wi 1helmi /.TANA- General Contractors Contractor Reg# WILHEJ*066RA
Address Post Office Box 1468 Expiration Date 12 / 01 / 97
City Belfair St WA Zip 98528 Phone# 360 275-0763
#3 If septic is located on project site, include records. D N (,0 '/� Q
Connect to Septic? x Public Water Supply x Well �% D
Connect to Sewer System? Name of System QV
(If residential, proof of potable water is required)
PERMIT gSSISTANCf CENTER
#4 / 32127 - 53 - 00107
0*I Description Lot 107, Division 4, Lake Limerick
#5 Building Square Footage:
1st FI 952 2nd FI 0 3rd FI 0 Loft 0 Basement 646
# Bedrooms 3 #bathrooms 2 Deck 487 Other
Garage 306 Carport N/A (Circle Attached or Detached?)
#6 Use of building Single Family Residence Describe work
Remove and replace approximately 466 square feet of roof sheathing and replace with
APR rated 7 16 OSB sheathing. Add one floor joist in garage ceiling. Minor deck and
sidi re air.
#7 Type o .ob: New Add Alt Repair x Other
#8 MOBILE/MANUFACTURE HOME INFORMATION N/A RECEIVEb
\
Model Year Make Model
Length Width — Serial No. AUG 2 U 1997
# Bedrooms # Bathrooms\\ Type of Heat
Purchase Price$
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property: N/A
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
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Show following on the site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Drainage Plan Wells
Septic Systems Easements
Proposed Improvements
Name of Side Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
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APPLICANT TO DRAW SITE PLAN BELOW
See attached
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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See attached
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N/A
Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 ea,
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
—Bath Basins Heatpump, Other
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_Bath Tubs No. Units Fees
Showers Furn BTU
Hot Water Htr — Heatpumps
`Laundry Washer — Vent Systems
I _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 16.75 — Auto Fire Sprink Sys 35.00
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TOTAL PLUMBING $ No. Other
Gas Outlets
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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 16.75
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 BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE I O
FOR OFFICIAL USE ONLY: Accepted by: Date: ".�
DEPARTMENTAL REVIEW
pppppppp FOR OFFICE USE ONLY
�Prov
ed Cond. Hold
Approval
Planning: �&;
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Environmental Health:
Building Plan Review L Sj3 — — Zo
l/e.a T I T 1-5-n ��'7-i c n VRA - A,�a\ I e v a q Z q�
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Occupancy Group Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Violation Fee
Site Inspection
Building State Fee
Other /� %cT "/, ,t � d
Other
Other
Building Valuation: TOTAL FEE lj