HomeMy WebLinkAboutBLD N/A Storage Only - BLD Application - 6/11/1997 06/1111997 14:02 3604791050 BUY RITE HOMES PAGE 02
Permit No.
MASON COUNTY
PRIT APPLICATION
426 W. Cedar/P.0, Box 186,Shelton,WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#t Owner Phone 0 31oo 930 - 0 -7 X9
Site Address AE� To bill) 45- t%.4 C � �#6'4.44o Fire District#
city ���..:. St Zip
Directions to Job Site
Owner Mailing Address 5 o%y, -
City St ZIp
Llen/Tltle Holder '�7-j..A-.- L1 .iL
Address 'P.o 1 p o-
City- St LJs-
#2 Contractor Name St 1 Contractor Reg#
Address _ �-0 . ;3 ex Expiration Date/ /
City St Zip Phone#
#3 If septic Is located on�pro.5o site, Include records,
Conned to Septic? X Public Water Supply Wish
Connect to Sewer System? Name of System
(If residential, proof of potable water Is required)
44 Parcel No.r2M4DQ - -7-5- -_2Q0/0
Legal Description t ea p &" J
#5 Building Square Footage: (exlsting/proposed)
1st FI_f/00 ?}T' /
Basement / Deck J A bedrooms_f #bathrooms i
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft.
#6 Use of building Describe work
S► 1
#7 Type of Job: New Add Alter Repair Other
#e MOBILE/MANUFACTURED HOME INFORMATION
Model Year I9VZ Make tr Model oa►k la�t�
Length_Width--! _Serial No. 6 71 g �
N Bedrooms__# Bathrooms Type of Hea
Purchase Price S gQP0
a9 Indicate by circling the applicable source H any water is oh or adjacent rty:
River Pond Creek Stream Wetland Lake Marsh Saftwat easonal Runoff Other
06/11�'1997 14: 02 3604791050 BIJ'Y RITE HOMES FADE 06
Plumbing Flxtures ($3 eacN EAR Mechanical Fixtures M ear.hl
No. _Toilets CIRCLE FUEL TYPE: Gas, ctric,
B Basins Heatpump, Other
Bath s ubI a
Showers F BTU
—.Hot Water Htr Heatpumps --
-Laundry Washer Vent Systems
Sinks Spot Vent Fans _
Floor Drains dQ, Boilers/CQmpreasoa,
Laundry Basins HP
Dishwasher Air Handling Units
—Disposal cfm#
Urinals N2. Fire Protection Systems
—Other _ Auto. Fire Alarm Sys 50.00
d Fire Supp. Sys 50.00
Permit Basic Fe 1520 Auto Sprink Sys 25.00
TOTAL P MBING $ Mal Qtw
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED 19 NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15,00
WORK IS SUSPENDED OR ABANDONED FORA 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 1 AM A CURRENTLY nmiSirnrn
Mr N T S of THE CONTRACTORS REGISTRATION LAW 0ON�f�iA0 0n IN f I IF Fl 1 A 1 F� (�F WA9I IINI I I I IN ANI) I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AMAwAREOETHFOHDINANCEREQUIREMENI'SHEUU-
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 BTAINING APPROVAL FROM FIRST OBTAINING AP�ROVAL FROM THE BUILDING
THE BUILDIN EPAR M NT. DEPARTMENT. ;
X I X BY OWNE .
DATE 1 DATE Ll
FOR OFFICIAL USE dtILY ACeBpt���?: ',`� ' � s Date:
l
06/2741997 14:05 3604791050 BUY RITE HOMES PAGE r 04
Show following on the site plan —
Lot Dimensions '' _ Flood Zones
Existing Structures Fences ✓
Structure Setbacks Driveways ✓ 5
Water Lines Shorelines r
Drainage Plan Topography v
Septic Systems ✓ Wells we
Proposed Improvements r Easements ✓
Name of Flanking Street Indicate Directional by (N, S. E, W)
Name of Fronting Street in relation to plot plan
rAPPLICANT TO DRAW S E PLAN BELOW ---
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW--
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