HomeMy WebLinkAboutBLD5404 - BLD Application - 10/17/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. yo
NAME t EMAIL ADDRESS CITY&STATE ZIP ✓�0 PHONE/
OWNER if, '/Gt� r �In S �.
DIRECTIONS O �'- A-"'q ►"
TO JOB L4 4 qL
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. S —Z 2 —o2 1—
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [I ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED 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
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
ontract or registration law RCW 18.27, and am aware BUILDING DEPT.
f the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. M VEHICLE PERMIT
A C TION AC P BY PLANS CHECK BY ADAROVEA FOR ISSNCE
Owner Date.
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATIO CK. .O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O.Box 186 Shelton,Washington 98584
MECHANICAL PERMIT APPLICATION
IMPORTANT-Complete ALL items.Mark boxes where applicable.
1. LEGAL DESCRIPTION
Location
Of N s
Building N s
E W side of feet E W from intersection of
Sect. Twp. Range
N0. DESCRIPTIONS FEE NO. DESCRIPTIONS FEE
1. Forced air or gravity type furnace or burner including ducts 14. For the installation or relocation of each boiler or refrigeration
and vents, up to.and including 100,000 Btu's--$4.00 compressor over 50 horse power or each absorption system over
2. Over 100,000 Btu's-$5.00 1,750,000 Btu's-$25.00
15. For each air handling unit to and including 10,000 cubic feet
3. Installation or relocation of floor furnace and vent, suspended per minute, including ducts attached thereto-$3.00
heater, or recessed wall heater-$4.00 NOTE: This fee shall not apply to an air handling unit which
4. Installation, relocation, or replacement of each appliance vent is a portion of a factory assembled appliance, cooling
installed, not included in appliance permit-$2.00 unit, evaporative cooler or absorption unit for which
a permit is required elsewhere in this Code.
5. Repair, alteration or addition to each heating appliance, re-
frigeration unit, cooling unit, absorption unit, or evaporative 16. For_each air handling unit over 10,000 cubic feet per minute
cooling system including installation of controls regulated by -$5.00
this code-KOO
6. Installation or relocation of each boiler or compressor to and 17. For each evaporative cooler other than portable type-$3.00
including 3 horse power-44.00 18. For each ventilation fan connected to a single duct-$2.00
7. Over 3 horse power to and including 15 horse power--$7.50 19. For each ventilation system which is not a portion of any heating
8. Over 15 horse power to and including 30 horse power-$10.00 or air conditioning system authorized by a permit-$3.00
9. Over 30 horse power to and including 50 horse power-$15.00 20. For the installation of each hood which is served by mechanical
exhaust, including ducts for such hoo"3.00
10. Installation or relocation of each absorption system to and
including 100,000 Btu'944.00 21. For the installation or relocation of each domestic type in-
11. Over 100,000 Btu's to and including 500,000 Btu's-$7.50 cinerator-$5.00
12. Over 500,000 Btu's to and including 1,000,000 Btu's Commercial or industrial type incinerators--$20.00
-$10.00
22. For each appliance or piece of equipment regulated by this
13. Over 1,000,000 Btu's to and including 1,750,000 Btu's Code but not classed in other appliance catagories, or for which
-$15.00 no other fee is listed in this Code-$3.00
FIELD INSPECTION Basic Fee $3.00
Date By Remarks TOTAL
Name JMailing address - Number, street, city, and State Zip code Tel. No.
Owner "
/ /
2.
a Contractor
3
The owner of this building and the undersigned agree to conform to all applicable laws of MASON COUNTY
Signatu of applicant Address/� 1`�i/q,a,sd Application date
DO NOT WRITE IN THIS SPACE - FOR OFFICE USE
App ve by Per it fee Date permit issued Permit number Receipt No.
SNCLTGN rRIN TINS Ge_