Loading...
HomeMy WebLinkAboutBLD96-01427 Cancelled Garage - BLD Application - 11/27/1996 Permit No. MASON COUNTY BUILDING PERMIT APPLICATION b, 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 �V� l��► PLEASE PRINT #1 Owner t 0�/I 13cJ7-Z!I P4 Phone# Site Address_ i S // �A�,p"' �mf}D Fi�a District# City St i',M' zip Directions to Job Site 01" e J % k 17 © y -r o �l y2[Z24, IT e6RR /� ZAAL7 Owner Mailing Address oe O gx-X3/S City AJIIW LIA 1PY5:2!� St Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name &�9 f;JFLD 62:2 S7gC-—r/i'e'°7 Contractor Reg#11)W 9TG Z 27 PT Address ¢0 J3ox 002 Expiration Date_,/,F 1-9j 2 City 4.a'On St 4,1,4 _Zip Phone# #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 residential, proof of potable water is required) ,,.,,, ,���tt/� Pa el No. '94�_` -( �--- ALrl Legal Description T12 J8 6 t �0r! P� 2l'1 S I � '�y8 #5 Building Square Footage: (existing g; 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage__C21�_/ Carport / (Circle:Attached or ache Other sq. ft. / #6 Use of building ��A�IA C� Describe work #7 Type of Job: New Add Alt Repair Oth4n q D W R D #8 MO ILE/MANUFACTURED HOME INFORMATION NOV 2 7 IN Mo Year Make el Length Width Se ial No. 31C A 1 'T H SE©V'CF0 # Bedrooms # Bathrooms Typ f He t "lC/''1L.' f 1 1'1 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 Flood Zones Existing Structures Fences 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) in relation to plot plan Name of Fronting Street APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.25 each) Fee Mechanical Fixtures ($6.50 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 16.25 _ 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 16.25 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 X BY DATE DATE i FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Pre- re✓r e.-AJ o K 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 A&I rLIJ�2 5 Other Building Valuation: TOTAL FEE joHN4CHt SMOA bU -) ILLS s(, 2 c-,�q i FfSH j.A}cE ROAD CI) TF"iSN 00 /90 L©T Ao WELL. To ,17�A1/JFI E1 T� -" `o l-j' ' ' �.ie may, 20 AN d Q n To �R�IN f�E1 D f PROX, /80'j'KoA' Li9/cf T�--, j)RAIt4f lElD ` 'joa l � -- --------- D1�'CfIESOJ�' S�R�lICS