HomeMy WebLinkAboutBLD95-00141 Cancelled SFR, Garage and Shed - BLD Application - 2/3/1995 Permit No. ���• �4
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1 800-562-5628 ��,Q U\
PLEASE PRINT
#1 O er -mom th rs P+JrV, hl c, ia�&,' Phone# '/dL 6 —S/l_S
ite Address E I I %o NEr U I J43 Pla.c.e Fire District# S
City C1,cuo" St CAA Zip 9d's'P1
Directions to Job Site NQrA e,n 8 tre,kdd c tt� f o le,h Con 0 n,a I've a, v IN U a h Fot-Gow
y m�t.e. o �S+n r,c bv,�r�v P l a,�.e rz.rs+ L04 04, b't 1,4,4
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Owner Mailing Address W Iko W 4h w Q-OA 1str
City S6e,L+ou. UJI St—WA—Zip 985TY
Lien/Title Holder Y 2,u Ad'y' ' 0 60 X- Gl a
Address LiY�' ' -�Ltea�
Clty �C�,��Srov. St LcJa¢ Zip
#2 Contractor Name hive, l\'4 L L:&V-' Contractor Reg#
Address UJ\8y Wu v., w n6 ., n9-- Expiration Date
City 2. St W el Zip TfK(p(f Phone#
#3 If septic is located on project site, include records.
Connect to Septic?
___X Public Water Supply Well C.or..w.,j"f J (,4,C i0.
Connect to Sewer System? Name of System SeJ L 7 l&L (eStc a ac�a L e up,L
(If re ' ential, proof of potable water is required)
7
#4 arcel No.-3
Legal Description L o i y_ -C'J! .2 6 i4 N Al -5- 1�
#5 Building Square Footage: (existing/proposed)
, 1st FI l S.3 / 2nd FI /3g6 / 3rd FI / Loft /
Z� Basement D / Deck U / #bedrooms _/ #bathroomsJ3--/
Garage--J-D" / Carport / (Circle:Attache or Detached?)
Other a, sq. ft.aZ S /
#6 Use of building S ;V%ALQ Fang W Describe work
#7 Type of Job: New_X Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model N
Length Width Serial No.
#Bedrooms #Bathrooms 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 Wetlan , Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences L
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)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFIL W
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Plumbing Fixtures ($3 eachj Fee Mechanical Fixtures ($6 each)
No. 3 Toilets 5 CIRCLE FUEL TYPE: Gas, Electric,
3 Bath Basins `I v v Heatpum , Other
Bath Tubs No. UaLt5 Fees
Showers , c _ Furn BTU
Hot Water Htr V Heatpumps
Laundry Washer Vent Systems
1 Sinks Spot Vent Fans
Floor Drains No. Boilers/Compressors
b Es Laundry Basins HIP
Dishwasher ? . Air Handling
Disposal _ cfm#
Q Urinals No. Fire Protection Systems
0 Other Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $�7 No. Other
_ Gas Outlets C
i Wood�� Pellet Stove
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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 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $G J
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 WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE A y DATE
FOR OFFICIAL USE ONLY: Accepted by: �M �_'�--- Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: S(A 10 1 eC A +0 AS-- 1 G 3 " 0111
Environmental Health:
Building Plan Review
Occupancy Group: — 2!n -hype of Const: S7N
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit $tip. _`T-C,
Plan Check cam-( .33
Plumbing Fee c�
Mechanical Fee (,3.
Woo as Pellet Stove
Radon Monitor s is
Violation Fee
Site Inspection
Building State Fee
Other
Other fl DD ob
Building Valuation: 13Y , b TOTAL FEE �j (�, �•325