HomeMy WebLinkAboutBLD96-01414 Cancelled Basement - BLD Application - 11/13/2007 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
#1 Russell !j K216 If-en Qcrfh Phone# n0 k'2
to Address /I/C ;&70 Lg/(e r,kAe Fire District#
City St i✓/4 Zip 9'oS 2g
Directions to Job Site lyor4 > er 1�-wv Le, Raj— -,a 1 5'LL
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Owner Mailing Address 1VF 2 7y
City p/SQ f y St 0)q-zip 9 2 S-:z.Y
Lien/Title Holder
T
Address
Clty St Zip
#2 Contractor Name ��v, L)n I.,r CS 0r1 �vy(' Contractor Reg#
Address P, C . x `f8 Expiration Date/
City - 'P�!R o St u)g,__Zip Phone# 7_?_� 6_23
#3 If septic is located on project site, include records.
Connect to Septic?_k-l' Public Water Supply ►Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 No. Z O� - - o 2-0
gal Description 2 t.c�esT �� llQ3ZC—
T� 40, 0 5v vu l I a/Lv5 Ire C. 5p 4P I a 3:�,
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement Deck? ' _ rooms
Garage / Carport / (Circle:Attached or Detached?YD
Other sq. ft. / � �IS fC),2 zino-tVco y
#6 Use of building A I' ew c 2. -- _-- - - escribe work Qf voS-ty u g1
Q
#7 Type of Job: New X Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No. NJ
# Bedrooms # Bathrooms Type of Heat -
Purchase Price$
� 7
#9 Indicate by circling 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
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 Fu rn 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 OWNER X BY
DATE DATE /(LZ,�, �9(p
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: Q
21kf6
Environmental Health:
Building Plan Review �' �,ti *�` °' ' '' t t,
W�•
l Z—Z3 C
Occupancy Group: 1_ y u-' Type of Const: t-"
Fire Marshal: TT
Other:
Special Conditions: FEES
2 1(. KO x !S— = 3 1( Building Permit
378 Y. G •s° = ?1, u 5-1 Plan Check
(tit os) Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee _r
Other
Other_ ,, OD
Building Valuation: Z 6 TOTAL FEE