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HomeMy WebLinkAboutBLD28829 SFR - BLD Application - 8/16/1991 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED lad PERMIT NO. NAME MAILADDRESS CIT TATE ZIP PHONE OWNER d/' r^s ; O0 �s D" z7 TO JOB SITE ( S 8 ITS, lu.,n- f , �c<�n ri'$ht o n flarrsfi' e 1404. s u �'h alp x, M� , �o pol`L n t k/i`l SaK l�ct, PARCEL LEGAL NUMBER 19 D21 DESCR. NAME NIAIL ADDRESS CITY&STATE LICUISE NO. ZIP PHONE CONTRACTOR USE OF BUILDING C J CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE � A / WORK Lam/ BEDROOMS DECKS `� CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. GARAGE I / CONDITIONING. NO.OF STORIES BASEMENT /l/0 ATTACHED y THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. 0 FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT 1 CERTIFY THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. XOWNER . re�ATE � � XBY DATE FOR OFFICE USE ONLY DEPARTMENT YESPPROVE NO DEPARTMENT YESPPROVENQ BUILDING VALUATION Z<�< HEALTH IWAPUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT — D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP _ � PRE-INSPECTION L SHORELINE WOODSTOVE PLUMBING ©� MECHANICAL STATE BUILDING FEE STATE SURCHARGE AP ICATION ACCEPTED BY PLANS CHECK BY D F UANCE PERMIT VALIDATION TOTAL g M ]� :l ( ? BY CASH CK O 1 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. OWNER NAME MAILADDRESS CITY&STATE ZIP cfi r!,XoPHONE \l1/I i 21c. '1- S 6 o 8 aj' e'e A"3 2 3 t7 DIRECTIONS TO JOB SITE p Ll 3 d S c PARCEL LEGAL NUMBER DESCR. NAME MAIL ADDRESS CITY&STATE ZIP PHONE L CBM NO. CONTRACTOR USE OF BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK r DESCRIBE WORK e ups f i zc S I AREA: NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING. BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR I ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. CARPORT SgFt FIREPLACE IS CARPORT/GARAGE GARAGE SgFt ATTACHED O DETACHED❑ OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE X BY DATE FOR OFFICE USE ONLY DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE MARSHAL BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL BY CASH CK MO PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 g( 427-9670 DATE ISSUED. v-) �� PERMIT NO. v OWNER NAME MAILADDRESS CITY BSTATE ZIP PHONE ,l; 9- e V)i - s 7 DIRECTIONS 7 1 TO JOB SITE tlkr6ss uvrL. ri h-t opt , lqv `;4L' RoA. SoL l-k clip r-7x'. .3 ",'I, f Po,'kf YVil SorL- l4c4- s LEGAL V � U DESCR. CONTRACTOR MAILADDRESS CITY&STA E LICENSE NO. ZIP PHONE USE OF BUILDING PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS l FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS ` -0c BOILER I COMPRESSOR 6.00 SHOWERS REPAIR/ALTERATION 6.00 ' WATER HEATERS �� REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER "�� AIR HANDLING UNITS 7.50 I SINKS HEAT-PUMPS 6 00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT p� LAUNDRY TRAYS FIRE SUPPRESSION 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISHWASHER DISPOSAL URINALS PERMIT BASIC FEE 3.00 PERMIT BASIC FEE 10.00 TOTAL TOTAL SPECIAL CONDITIONS: NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. OWNERS AFFIDAVIT: I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF CONTRACTORS AFFIDAVIT: I CERTIFY THAT I AM A CURRENTLY REGISTERED THE CONTRACT OR REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON CONTRACTOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE ORDINANCE COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL REQUIREMENTS REGULATING THE WORK FOR WHICH THIS PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM TH BUILDING DEPARTMENT. WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER r' '— X BY DATE FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY BU DING GROUPP D SSUANCE PERMIT VALIDATION j'- / r -M,\ I BY CASH CK MO