HomeMy WebLinkAboutBLD97-0181 Cancelled Deck - BLD Application - 6/1/1999 Permit No.
MASON COUNTY QY 0 n
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT / Q/ E
#1 O er� rir'¢, Sam vgg Phone# 3 60 W �(.O R 8 6
ite Address 4 - S / 4&&US Gr Fire District#
City �f/EL7-d/1/ St L</A Zip ?Z-85/
Directions to Job Site% 3 A/, M.#Sa^- L K /Z n . 4,-FT4 AI ozz ti we To 4,4ke-
4 1 M-cirl i, Ri EH T l E r T �.
A4 H. ✓N/TE /,�r��F��I'aiid
Owner Mailing Address DST �13OX ;,Z 3 / S
City SifEL-raltl 4f/,4- 2'5S5-'5y St Zip
Lien/Title Holder
Address
Clty Zip
#2 Contractor Name S X wn.f Con r Re
Address ExpiriM ate. 1.
City St Zip Phone
#3 If septic is located on project sX'e, include records. ly SF9
01
Connect to Septic? Public Water Supply Well
Connect to Sewer Syst Name of System
(If residential, proof of potab water is required)
N
eegal
No.
Description
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of mg l�tc,K Describe w�k ,r/C uL:T
#7 Type of Job: New_ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
# Bedrooms #BWbr ms Type of Heat
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
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)
in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
C
00
K
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
tfQ �
1
I �
Yam'
Plumbing Fixtures ($3.35 each Fee Mechanical Fixtures ($6.75 each)
No. _Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins / Heatpump, Other
Bath Tubs No. Units Fees
Showers Fu rn BTU
Hot Water Htr Heatpumps
_Laundry Washer _ Vent Systems
Sinks Spot_ Spot Vent Fans
_Floor Drai No. Boilers/Compressors
_Laundry Bas _ \ HP
Dishwasher No. Air Handling Units
e
_Disposal _ cfm#
Urinals No. Fire Protection Systems
Other Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 1 5 _ 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 16.75
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 Ate ORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NTCHANGES.SHALL BE MADE WITHOUT
MADE-WIT�OUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE,B�lI1.Dl C3-DEPARIYENT. DEPARTMENT.
X OWN ! X BY
DATE — DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: K41 t I1 S 0 ~
Environmental HE
OWNER/BUILDER TO ASSUME ALL
RESPONSIBILITY IF DRAINFIELD
AREA IS ENCUMBERED.
Building Plan Review L.C.
3
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
oG
(o 46 Building Permit 3�'
Plan Check ob
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other `P
Other
Building Valuation: C� TOTAL FEE