HomeMy WebLinkAboutBLD95-01480 Cancelled Garage - BLD Application - 3/18/1996 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
T edar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
426W. 0
?LEASE PRINT
#1 Owner �-��� "'k' Phone# f Zt- 2'11 l
Fire District
Site Addres \ a\ o.n��r�—..r #
City ��Vt A.k o%&
St��a Zip q�sSB�P
Directions to Job Site V�ro d V hk o
el
Owner Mailing Address `E \`A I S �o`^br �'
St Wa Zip '�FSg`{
City
Lien/Title Holder N
Address St Zip
Clty
N- ontractor Reg#0. N
#2 Contractor Name 19\r%\nv1 u S CuSfov1 —i
Address 2Qo S E. �0 �k� ��} �"�- Expiration Date._/
City. Sena-�A St v.�� _Zip_�ff s& Phone# t�Z 1. —
#3 If septic is located on project site, include records.
Connect to Septic?�Public Water Supply .0' Well
Connect to Sewer System? .k�`— Name of System
(If residential, proof of potable water ss required)
#4 Parcel No. k
TW N
Legal Description
#5 Building Square Footage: (existing/proposed)
IlX
1 st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Othe GTi 11 /
#6 Use of building �T ��G�--' Se w m� ek Describe work :� w
a it No wad
tW� �w 0 t obc ro h� C dV0,9Q 1r'C0.Ma� �v. rio Wo SP�CR
A
#7 Type of Job: New _Add Alt _Repair Other
#8 MOBILE/MA ACTURED HOME INFORMATION
Model Y r ake Mo el
ngth Width Serial o.
#Bedrooms # Bathro s 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 Wetland Lake Marsh Saltwater Seasonal Runoff Other �
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
r
Approved Cond. Hold
Approval
Planning:
V
I
i
Environmental Health:
Af
Building Plan Review
�f q�
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: �, d TOTAL FEE O
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ( 6 each)
ti
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 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 Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL 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 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 OWNER X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: Date: