HomeMy WebLinkAboutBLD93-00058 SFR - BLD Application - 1/20/1993 DEPARTMENTAL REVIEW Permit No.BLD
MASON COUNTY
FOR OFFICE USE ONLY BUILDING PERMIT APPLICATION
�..ew PLEASE PRINT
planning:
#1 Owner 5146N NNq FAAftC ASC-J Phone# H v ^ 03 731
Site Address _E A.-IC 5L&AJ:0A13 RD.
City Si4ku `uq State LJA- Zip e'gs'Sy
Directions to Job Site c?-N4 FfgtZ. 3 -- L6FT— OAJ n4"At LK &0 t�-^x
Environmental Health: l� IhJLt✓S - TUAKI QI6,V pu CLoi.JRKiL'rq pWJt ism AoAa Nsr —.PA Al Taisgn ,-T,,uw
V\ 0( f+iLL ON eto10K11L7q "•- 744 an oeT oN SqAfejeg do TT-c fnlA Lc7S 40c4764
DN jZ-1• Stdkr 0 F R4), J SST 3EFC94-- Car.- Ot,SA-C-
Owner Mailing Address 5-013 S /(,rr+ 'S
Building Plan Review:
city SN-EtroN State LJA- Zip 98s�y
/ Lien/Title Holder
oOG� i� Address—
Occupancy Group:,e �oLs� /OV is_ P
Fire Marshall: #2 Contractor Name Contractor Reg #
Address Expiration Date
City State Zip Phone
Other: #3 If septic is located on project site, include records.
Connect to Septic? kS Public water Supply ' k-5 well
(If residential, proof of potable water may be required. )
FEES #4 Parcel No.
p Legal Description DIV S LoT` 3a L.A-KE L1 * 4tCK, r
S ecial Conditions: S ite Ins ection
;lee #5 Building Square Footage: (existing/proposed)
BOui dinq Permit � 1st Fl / 2nd Fl / 3rd Fl / Loft
Basement / Deck '7 1 / #Bedrooms 3 #Bathrooms /
Violation Fee Garage / Carport (Circle:' Attached . or Detached?)
Other sq ft /
Violation Investigation Fee
#6 Use of building Rt5ii3kN�f Describe work 1M$7 CL 3k-Pric 3y A,
G�9n'�ol•1%�/` STvrt,4G x ��� PO -IN I ik#Lr Tjk0cwAJS - - 4 CA-#0-P0Lr- ur,-O 'X t Z
Plan Check 5- Cffl-A .-&- 3uu.0inr(, - rMsrA-LL 51410-rIAI& - Ote+ Ti-,4.vr) 4,ua 4,4.+vd Se.-Pt
#7 Type of Job: New _ Add Alt Repair Demolition
Plumbing Fee Woodstove Re-roof Bulkhead Other
Mechanical Fee ' #8 Mobile Home Information
` Model Year 1991 Make GuCM)CM Model
Woodstove Fee Length t-10 Width ;L1 Serial No.
Z� #Bedrooms 3 #Bathrooms a Type of Heat .C-LECT.
Building State Fee
Building Valuation:
#9 Any water on or adjacent to property: Saltwater. Lake River
Pond wetland Seasonal runoff Other
'
TOTAL �
Plumbing Fixtures ($2 .00 each) Fee: No. Boilers/Compressor Fees:
Show following on the site plan No.__�-_Toilets 0-3 HP 6.00
Lot Dimensions Flood Zones Bath Basins 3-15 HP 6.00
;Existing Structures Fences t� Bath Tubs 15-30 HP 6.00
-+Structure Setbacks Driveways-'-Water Lines Shorelines Showers� 30-50 HP _ 6.00
Drainage Plan Topography f _Hot Water Htr + HP 6.00
:Septic System Wells 50
`FProposed Improvements Easements Laundry washer
'fName of Flanking Street Scale: Sinks, NO. Air Handling Unit
Name of Fronting Street g
Floor Drains <= 10, 000 cfm. 7.50
Date:
Laundry Basins > 10, 000 cfm. 7.50
APPLICANT TO DRAW SITE PLAN BELOW _Dishwasher
Disposal Other
Urinals Evap Coolers
��o'► SEPTIC- S T Other Hoods
S q ST'tM Fire Suppression
Permit Basic Fee 3.00 Domes. Incin.
%�\ h TOTAL PLUMBING $ Comml . Incin.
'�y carcPoQ= ,
� Reloc/Repair 6.00
Mechanical Fixtures Gas Outlets x 2 .00
No. Fuel Types Wcodstove separate
vEcK a- Furn < 100K BTU 6.00 Other
Furn >= 100K BTU 6.00
Furn - Floor 6.00 Permit Basic Fee 10.00
Q_
9- bs' 1n Heat Pumps 6,00 TOTAL MECHANICAL $
h Vent System x 3 .00
� "1 � Vent Fans x 3 .00
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED.
Mo61L� __
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
Dtt�
�'q�poQT I certify that I am exempt from the requirements of the I certify that I am a currently registered contractor in
contractors registration law RCW 18.27 , and am the State of Washington and I am aware of the
aware of the Mason County Ordinance requirements for ordinance requirements regulating the work for which
which this permit is issued and that all work done will the permit is issued and ail work done will be in
be in conformance therewith. No changes shall be conformance therewith. No changes shall be made
made without first obtaining approval from the Building without first obtaining approval from the Building
Department. Department.
X OWNER i- -- X BY
r-
DATE:_ % `j-<i�, DATE
Return permit to: Department of General Services 426 W. Cedar Street/P.O. Box 186
Shelton, WA 98584 427-9670/1-800-562-5638
FOR OFFICIAL USE ONLY: Accepted by: �A . .� Date:J U