HomeMy WebLinkAboutBLD94-00313 Cancelled SFR - BLD Application - 6/7/1995 MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O.Box 186 Shelton,Washington 98584
(360)427-9670
BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
March 6, 1995
RE: Permit # Q",q �1
Dear
On U /o this office approved for issuance the above
permit number. Pursuant to the Uniform Building Code, Section 304,
this permit, once approved for issuance, must be issued within 180
days to stay valid. Failure to pick up the permit within the 180
day time frame will void the permit and it will be necessary for
you to re-apply for the permit thus, meeting all new review
requirements.
Further, the Uniform Building Code, section 304 allows for the
collection of the plan review fee if a plan review has been
performed and the permit cancelled. In the event that you no
longer require the permit or choose to cancel the permit, the plan
review fee due on this permit is $ -3\ The check or money
order should be made payable to the Mason County Treasurer and
submitted to this department for processing. Once the plan review
fee is paid, we will return the plans to you and cancel the permit
request.
If you wish to obtain your permit now, the amount due for your
building permit is $ \\ Lo._QL. Once received, we will issue
the permit, either in the office or we can process the issuance
through the mail . -The permit will remain valid for a period of 180
days. At the end of this 180 days, an inspection will be required
or a one-time only extension can be granted through letter request
however, all future extensions must be granted by progress
inspections.
Please respond to this notification prior to April 7, 1995 .
incere }
Cheryl / gan
Building�Depa ment
(206) 427-9670
CC: Property File
' J Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT L h
#1 Owner Phone# 2.n
Site Addre ,'30/0tT -,o jn ZAke ri if Fire District#
City St Zip'T�`�Slt",
Directions to Job Site ,�,�'�.rc./d —f—r. �I a_50 'Or) rls� h � _
r °
n C — o
Owne ailing A dress /S t d'
City St . Zip O
Lien/Title Hold e I"1 -ec ,m.�. rya v•
Address
City S St Zip
#2 Contractor Name —' v Contractor Reg#
Address -5— Expiration Date
City T-a on rYN St J,4,&fah, Zip dl SZ/0"7 Phone#
#3 If septic is located on project site, include records.
Connect to Septic? - Public Water Supply Well ✓ Q 8�
Connect to Sewer System? Name of System O\o 024
(If residential, proof of potable water is required)
#4 Parcel No.,;0,2_33 - 6_�2 -00044;j� p► Q
Legal Description %�QQ�ihfiS 5(�C'.1r1 �/ � r'� ��� �'` �R'3'
#5 Building Square-F-Qotage: (existing/proposed)
1 st 2nd FI / q1 1 3rd FI / Loft /
e ;�,
ase_ / Deck / #bedrooms / #bathrooms arage / Carport / (Circle:Attached or Detached?)
Z z__Other sq.ft. /
#6 Use of building /;, —��J!I Describe work
f40 S £�
#7 Type of Job: New_,'��__Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Mod I Make Model
Lent�_Width Serial No.
# Bedrooms # Bathrooms Type of Heat
Purchase Price$
#9 Indicate by�cling the applicable source if an 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)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
�� c� C
a
' rb
P
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Ljj
L �
1
Plumbing Fixtures G 3 eachl Fgg Mechanical Fixtures ($6 each)
NQ_Toilets 1 CIRCLE FUEL TYPE: Gas Electric,
Bath Basins 1 Heatpump, Other
Bath Tubs ` No. Units Fees
_Showers Furn BTU
LHot Water Htr _ Heatpumps
p' Laundry Washer Vent Systems
Sinks Spot Vent Fans ✓v V
Floor Drains No.. Boilers/Compressors
Laundry Basins _ HP
J
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
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $
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 9 DATE
— — - --
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW IN
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: Zz`
Environmental Health:
Y A
�l•ICT C"7'N Q )T ILA. ��y -5Z��l� �T��
Building Plan Review
Occupancy Group: f?- Type of Const: S�
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check 3�
Plumbing Fee 3.UO
Mechanical Fee .j( . C )
Wood/Gas/Pellet Stove aSOc'
Radon Monitor •(z
Violation Fee
Site Inspection
Building State Fee 4,5c
Other ao
Other
Building Valuation: TOTAL FEE