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Home My WebLink AboutBLD98-00049 Cancelled Deck - BLD Application - 1/23/1998 Permit No.PJ,1)9$�O�y 1 MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670 (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269) PLEASE PRINT 11 O er � !/�� C�II� G ,l� Phone# yZ�-- 7 S y- Site Address - l be �r/ Fire District# City St Zip fj�s-( Directions to Job Site f MgWan- Owner Mailing Address City 57/c/ Zoy St l✓ Zip��'S eV Lien/Title Holder �LLSYI (2 Address City - St Zip #2 Contractor Name UBI # Address Contractor Reg# City St Zip Phone# Expiration Date #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System (if sidential, proof of potable water is required) Parcel No. 13 Legal Description 2 143 01CnEnE #5 Building Square Footage: 1st FI 2nd FI 3rd FI Loft Basement # Bedrooms # bathrooms Deck -2Zy Other p2 G! Garage Carport (Circl Attache r Detached?) #6 Use of buildingl1iC t L oQ Qcacd&l 0d �_� Describe work #7 Type of Job: New Add Alt Repair �t #8 MOBILE/MANUFACTURED HOME INFORMATION IAN �J � d Model Year Make o Lengt # Bedho s idt # Bathroo Se al No. Typ of Heat PERMIT ASSISTANCE CENTER Purchase Price$ #9 Indicate by circlingilhe applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other f fin+ Kv.aw ►how 4Wr d1d114i Sea e-reV;Akded -rva loch to �vyt �o �e�, yr 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 all A _ Z�7 fC)0�41 EY 0 y eh C-r-& APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW r Plumbing Fixtures ($3.45 eachl Fee Mechanical Fixtures ($7.00 each 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 17.25 _ 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 17.25 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 TH REWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FI T BTAINI APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DE R ENT. DEPARTMENT. X OWNER X BY DATE 20 �' �^ DATE FOR OFFICIAL USE ONLY: Accepted by: 4/ L x . Date: Z DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: O CJP-C'EK <.cy✓S�iw � � f{RF r rytu rj I Oftwrm G � AIL CA S 4ef2�c OWNER/BUILDER TO ASSUME ALL Environmental Health: RESPONSIBILITY IF DRAINFIELD AREA IS ENCUMBERED. Building Plan Review 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,&N U, 1-1 C 774 p U Other Other Building Valuation: TOTAL FEE BUILDING PERMIT ## q C9,11 Qw�jr DATE I 2� � Y Sd �Q� ,✓�Rl� Planner Area HR � n3 W'e"'r, 'IS 213y- - I I 'COO � CHECKLIST FOR PROPOSED CONSTRUCTION Yes No [ l [ ) Within 200 FT of designated shoreline, wetland, or associated wetland Where? �"`v(, [ ] [ ] Proposed construction on/over/in wetland [ ) Proposed construction within floodplain [ ) Eagle nest State road access needed [ ] [ ) Commercial Development (parking standards, sign ordinance, public works review, other applicable agencies) [ ] [ ] Mobile Home or RV Park [ ) [ ] Exempt from building permit application [ ] [ ] Exempt from SEPA process (WAC 197-11-305, WAC 197-11-800) [ ] [ ] Meets all requirements (which section (s) of SMP does proposed construction pertain to?) [ ) [ ] Variance or Conditional Use Permit required [ ] [ ) Exempt from Shoreline Substantial Development Permit process (Wac 173-14 -040) I ] I ] Exempt from Substantial Development, but within Army Corp. jurisdiction (WAC 273 -14-115) [ 1 I l Address needed 1 D]