HomeMy WebLinkAboutBLD92-0640 Cancelled SFR - BLD Application - 12/17/1997 MASON COU -'
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner "fit Phone# Z7S - l8
Si to Add.T-ess = IZ0 Ci ty-T'�hu u A S Zip S
Owner Address = c;.Co fins r. Ci ty �T,�_St ip S-
Li en/Ti tl e Holder
Address Ci ty St Zip
Describe Work S u c. eJ1'4'p_ V, C�
#2 Contractor Namea9__Dke_LAO�HSoh NC-.Cont_Tactor Reg �.L�LL0
Address L=-70 I vt t i S rtm C'
E=izaticn dace-
Ci
ty �+ t' St ip Phoneme_2S 3
#3 If septic is located on project site, include records.
Connect to Septic?— �- Public Water Supply_ Well
#4 Parcel No. 3 3 ( _5 _ �`{
Legal Description j10 Z 4--(ST _r
#5 Buildin Square Footage: (e st_n9lproposed)
1st FI 2nd F1 / 3rd F / Loft _
Basement_ Deck / Garage / Carport /
;bedrooms / #ba throoms /
Other sq ft /
#6
,� Use of building e s t�f-vn C.
m7 Tvoe of Job: New Add Al t Repair Demoli tion
Plumbing Only Mechanical Only Woodstove Re-Roof
Bulkhead Other
#8 7 in Fi rA c ^;P�umb Q �- `s �`fe..hani cal r_xtures
No. -2- Toilets q No. Fuel Types No. Air i Handling Units
I Bathtubs 2 Fura < 100K BTU <= 10000 cfm.
! Showers r Z
y Furn >- 100K BTU > 10000 cfm.
2
Ba t+a basins � Furn - Floor Other
Tsinks Heat Pumps Evap Cool ers
Dishwasher Z vent Systems Hoods
Hot Water Htr z 4 Vent Fans ' Domes. Intro.
I Laundry Washer z Boilers/Compressors Comml . Incn.
-
Floor Drains �5 0-3 HP Re l oc/Repair
Other 3-15 HP Gas Outlets
3 15-30 HP Woodstove
30-50 HP Other
50 + F£V
-I,.D
#9 MOBILE Orfr' rNFORM(ATTON
Model Year Make Model
Leng=t Widt.12 Serial No .
RBec: -ocros ,Ba=.rooms
rr
I 0 Any wa cer on or adjacent to property: sal t-.-a cer Iake
river pond wetland seasonal r•.lnoff
Show fo1aowing on the site plan Directions to job site
Lot Dimensions Flood Zones
zxisting Structures Fences Structure Setbacks Driveways
Water LiZ - Shorelines
Drainage Plan _ -Topography r�
Septic Sy_stp-ms Wells
Pro'cosed Improvements Easements
Name of Flanking Street
Name of Fronting Street
I
Scale:
Date:
APPLICANT TO DRAW TOPOGRApHy PROFILE BELO
,NOTICE: THIS PERMIT BECCm--S WLL AND VOID IF WORK OR CONSTRUCTION
A=OR_IZED IS NOT COM2--IENCED WITHIN 180 DAYS , OR IF CONSTRTJCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 190 DAYS AT AFTER WORK
IS CON.LMED
OWNERS Ar^TDAViT CONTRACTORS AFFIDAV.1
I CERTIFY THAT_I _AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCS! 18.Z7 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON' COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. 90 CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE. BUILDING
DEPARTMENT. DEPARTMENT.
x OWNER I BY �-L--
0ATE DATE
Return pp={ t to: Department of General Services
426 W. Cedar/P.0. Box 186, Shelton, PEA 98584 427-9670/1-800-562-5628
FOR. OFFICSAL USE ONLY: Accepted by Date. c
DEPAR AL REVIEW
FOR OFFICE USE ONLY
Approved Cond Hold
Approval
Planning: �
Eavi-onmentaI Health:
Building Plan Review: "j?i 4'3V---
Fire Marshall:
=Other