HomeMy WebLinkAboutBLD97-01436 Cancelled Shed - BLD Application - 1/9/1998 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269) n
PLEASE PRINT f ry� l
#1 Owner F. r1�FTd 'r� J� / Wh'?rSDN Phone#
ite Address LDS S /ti Fire District#
City. , E/",J AJ St Zip �S8
Dir ctions to Job ite
Tl.�-�N ICE, Y)'1I 6r4
pus D A-D- 04 01 C >;A-V J2i l - � Zifbk
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Owner Mailing Address
City I5b3 E ��1`1 f 5 Ta St Zv%� Zip `&1-S?
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name '15� UBI #
Address Contractor Reg #
City St Zip Phone# Expiration Date
If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 el No. 3ZI 36 - /S -qO 16� / /
Legal Description /D-� A� tcfQb �/`7 y
#5 Building Square Footage:
1st FI 2nd FI 3rd FI Loft Basement
# Bedrooms # bathrooms Deck Other' 1 ��if
Garage Carport (Circle: Attached or Detached?)
#6 Use of building Describe work
#7 Type of Job: New / Add Alt Repair t
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MOBILE MANUFACTURED HOME INFORMATION a
Model Year Make Model DEC 3 0 1997
0�- Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat PERMIT ASSISTANCE CENTER
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
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
APPLICANT TO DRAW SITE PLAN BELOW
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T
10
7t::, y,
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures 3.35 each Fee Mechanical Fixtures j$6.75 eachl
No. _Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Systems
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
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
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 OWNE"aW Id X BY
DATE �z'�JQ ' DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
A
Environmental Health:
Building Plan Review Z LLD q
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
Other
Other
Building Valuation: TOTAL FEE