HomeMy WebLinkAboutBLD93-00724 Cancelled SFR - BLD Application - 10/16/1995 Pez-=t No.B
MASON COUNTY
BUILDING PERMIT APPLICATION .p"`��-
PLEASE PRINT
1 Owner �) (A) l S Phone# 4 q
Site Address I 7 K
City 11:::�
S t 1 A 'dip
Directions to Job Site 1, 1?
Url 1
T
Owner Mailing Address
City=L —o A I St GC//U Zip
Lien/Title Holder
Address
City -St Zip
#2 Contractor Name a 171 l� /')C.c�ontractor Reg#
Address Expiration date
City St Zip Phone
#3 If septic is located on project site, include records.
Connect to Septic?_ Public Water Supply Well
(If residential, proof of potable water may be required)
#4 Parcel No..3�P 19 75300 19 7
Legal Description i.E V, *.1ILL— -D 7 L� ) C?
#5 Building Square Footage: (existing/proposed)
1st F1 2nd Fl / 3rd Fl / Loft /
Basement U AZ Deck / #bedrooms�_ #bathrooms
Garage / Carport / (Circle: Attached or Detached?)
Other sq ft /
#S Use of building�h iv► iF Describe worIc
47 Type of Job: New ✓ Add Alt Repair Demolition
Woodstove Re-Roof Bulkhead Other
48 MOBILE HOME INFORMATION
Model Year Make Model
Length_ Width Serial No.
#Bedrooms #Bathrooms Type of Heat
:9 Any water on or adjacent to property: saltwater_ lake
river pond wecland seasonal rurcf
ocher / cam,&SK
Show following on the site plan
—b�
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Sentic Systems Wells
proposed_7 rovements Easements
Name 0 1: z i=j. Street Scale:
Name of Frodting Street Date:
APPLICANT TO DRAW SITE PLAN BELO
APPLICANT TO DRAW TOPOGRAPHY PROFILE 9ELOW
a i
Plumbing Fixt• r-2s ( S2 each) yes �OZj
=
No. / Toilets y Vent Systems Xi -00
.,Bath Basins _ 3 Vent Fars X 3 . 00
LBath Tubs 3 No. Boilers/Compressors
/ Showers 0-3 HP 6 . 00
-THot Watar Htr 3-15 HP
00
Laundry Washer 3 6.
15-30 HP 6 00
Sinks 3 3 0-5 0-S.D
6. 00
Floor Drains 50 + LIP 00
Laundry Basins No . Air Handling Unit
,Dishwasher <= 10000 cfm. 7• S0
Disposal > 10000 cfm. 7.So
Urinals other
Other Evap Coolers
Hoods
Permit Basic Fee , Fire Suppression
TOTAL PLUMBING $ Domes . Incin.
r� Comml . Incin.
f�
Reloc/Repair 6 . 00
Mechanical Fixtures Gas Outlets X 2 . 00
No. Fuel Types Woodstove separate
Furn < 100K BTU 6 . 00 Other
Furn >a 100K BTU 6 . 00
Furn - Floor 6 . 00 Permit Basic Fee
Heat Pu=s 6 . 00 TOTAL, MECHANICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAY RCW 18.27 , AND AM AWARE (N THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DOME WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SMALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
1'x OWNER �;� �. x By
DAIS OA7Z
Return permit to : Depar=ent of General Services
426 W. Cedar/P .O. Box 196 , Shelton, PIA 98584 427 -9670/1-800 - 562 - 5623
FOR OFFICIAL USE ONLY: AcceDCed by: Date : C�
FOR OFFICE USE ONLY
--� Approved Card Maid
Approval
Planning:
AAR
Environmeatal Health:
B lding Plan Review: fD / lfSC&noi rf�b�/
Occupancy Group:
Fire Marshal:
Other:
FEES
IISPecial Conditions: II Ilsite Inspection I II
II IlBuilding Permit
if
II II Violation Fee I II
II II I. '1
II II Violation Investigation Fee I II
II II I
11 II Plan Check a�
II I
II II IlPlumbing Fee ,1
II II H 1 3� 1+
II 11 11Mechanicai Fee11
II II 1 ! 3�. it
II 11 IlWoodstove Fee
II I II
II II I 5 I
I II IlBuilding Stace Fee
I
11Sui1dizg Valuation: II 11 TOTALI
�- 5�3•