HomeMy WebLinkAboutBLD95-01180 Cancelled SFR - BLD Application - 8/8/1995 D ECEOVE00
n Permit No.
�1 AUG 91995 MASON COUNTY 41Da
BUILDING PERMIT APPLICATION
GENERAL SERMESCedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 n e r _ i_ i</ i;, __ _ Phone 7S- l
ite Address _ Fire District#
City St Zip fs
Directions to Job Site
a L L< - IN, w�
L e A /w14
Owner Mailing Address
City ^ St Zip n
Lien/Title Holder `�
Address-4 -y S�/c,L•�-
Clty rlej "/ St
-fc
�{�Q tract �� g3o 3io
#2 60tractorName 'J�
Address -3 go ��,�A l� /1 2��
City �Aca,.. St w LMiratio,/
Pholsi -
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply.._Js�� II
Connect to Sewe Name s um L L)
(If residential, pr of of po le water is r uire
#4 Par No.
egal Descriptio 7
#5 B ' re otage: (existing/propos
t FI 2nd FI / 3rd FIT / Loft /
Basement Deck / #,bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other so.ft.
#6 Use of building Describe work
/z
: New#7 Type of J Add Alt Repair Other
#8LLength
BILE/MANUFACTURED HOME INFORMATION
el Year /9q 7 MakeriEf- ?�Model c_�
7 0 Width 1/ Serial No. 1/y 2i3 yN17/D S/
drooms Z- # Bathrooms 2- Type of Heat 0�S - C'a..c 51 �``chase Price $ -7s6
#9 Indicate by circling the applicable source itknywzW is on or adjacent to subject property:
River Pond Creek Stream Wetland Marsh Saltwater Seasonal Runoff Other
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 Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
5 14 C ea
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T �y�
o-{�e 3 c
y l�
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tiT
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
8o w� v 91 f
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90
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82 Rv o
09
B3
neps
4�y', ,sfi ,,Y n �,•ot•q'sr
SUBJECT PROPERTY ---� ;•o ,av
05
n r. 87
86
�. J i5ii fee np'
Plumbing Fixtures ($3 each) F�,g Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
�ath Basins H ,atpump, Other
Ba Tubs No. nits F
Sho rs urn BTU
_Hot Wa r Htr H tpumps
_Laundry sher _ Vent Systems
Sinks Spot V nt Fans
Floor Drains No. Boilers/Compressors
_Laundry Basin _ HP
Dishwasher/ No. Air H ndlin i
_Disposal cfm#
i
Urinals ' o. Fir Pr io m
Oth Auto. Fire Alarm Sy 50�00
Fixed Firs Supp. Sys 50.00
P mit Basic Fee 15.00 _ Auto Fire/Sprink 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 Per it Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD T TAL 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 OF THE 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 OUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
t)1LDIN DEPARTMENT. DEPARTMENT.
X OWNER % i - T X BY
1
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
I
DEPARTMENTAL REVIEW • .
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: M IA L I I - St-/ B OC KS cl S"41O J vs
Brll d
Environmental Health:
Building Plan Review cr-
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE