HomeMy WebLinkAboutBLD97-01204 Cancelled ATF Porch - BLD Application - 10/14/1997 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 O l
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
PLEASE PRINT —7 �7
#1 ner _ / , Phone / '�7
/ ite Address 14190 nE Fire District#
( City St W19 Zip 5�20
Directions to Job ite
Owner Mailing Address S I9m67 d 5 A6206-
City St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name kI Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on proje;'U'b1lic
e, include records.
Connect to Septic? Water Supply Well
Connect to Sewer Syst ? Name of System
(if residential, proof potab a water is required)
#4 t
cel No.�3al Description
#5 Building Square Footage:
1st FI 2nd FI 3rd FI Loft Basement
# Bedrooms #bathrooms Deck Other
Garage Carport (Circle:Attached Detach
#6 Use f building VC-- ( 0-yN►� , 1� Describe work
#7 Type of Job: New Add Alt Repair Other �o
3
0
#8 MOBILE/MANUFACTURED HOME INFORMATION N �
Model Year ake/ Model
Length Width Serial No.
# Bedrooms Bath oms Type of Heat',
Purchase Price$ ?�
#9 Indicate by circling the applicable source if any at is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake h Saltwater Seasonal Runoff Other
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
1�OSt LC
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r� Pam,:
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
—Bath Tubs No. Units F
Showers Furn BTU
Hot Water Htr _ Heatpumps
—La\L dry Washer _ Vent Systems
Sinks — Spot Vent Fans
_Floor Drains No. Boilers/Compressors
Laundry BAtns — HP
Dishwasher No. Air Handling Units
—Disposal \ — cfm#
Urina No. Fire Protect* n m
O er — Auto. Fire AI rm Sys 50.00
Fixed Fi7Supp. Sy 50.00
Permit Basic Fee 16.75 — Auto F*r Sprink Sys 35.00
TOTAL PLUMBING $ No. Othe
G s Outlets
ood, 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 16.75
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- LATINGTHEWORK FORWHICH 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 C X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: l/u
ld/J�
Environmental Health:
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
Other
Other
Building Valuation: TOTAL FEE