HomeMy WebLinkAboutBLD0308 SFR - BLD Application - 10/9/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. L� o
OWNER ME AIL ADDRESS CITY&STATE ZIP PHONE
I. �>��nr)e-A J - 7
TDO JOB SITE a n (p u Up /»r G /X T ta?
PARCEL LEGAL /, '
NUMBER DESCR. W SF, WnTB OF
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
wneg
USE OF
BUILDING
CLASS OF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE _
WORK CiL� 6 /QQCa✓ Oil&PIS
-erne
BEDROOMS_ DECKS CARPORT__ JO _ NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS O AL GARAGE CONDITIONING.
NO.OF STORIES —L BASEMENT i ATTACHED C THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
/� �� 6: COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT�„� FI REPL` �_ DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE -AJO—
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY!THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGIST 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 O NANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT I SSUED AND ALL WORK DONE WILL BE IN
IN CON ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO ANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDI EPARTMENT.
X 4ER& -DATE '&-QC� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES No YES No BUILDING VALUATION C
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING 2� PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
12 Z c j j L' WOODSTOVE �1
PLUMBING
� MECHANICAL
U r STATE BUILDING FEE
STATESURCHARGE
41PPLICATION ACCEPTED BY PLANS CHECK BY APPROVED F SSUANCE I PERMIT VALIDATION
Lr_ L �.� IBY' CASH CK MID TOTAL
PLUMBING & MECHANICAL PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 ,C
427-9670 DATE ISSUED O tS
PERMIT NO. t 3 04
OWNER ME ADDRESS ITY TE ZIP PHONE
a PLI& '
DIRECTIONS
TO JOB SITE �� l ��(;�/ q teal - /� 3'% f�C!/SJ�iE'f' /y7 '
LEGAL
DESCR.
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF
o2 el
BUILDING
PLUMBING FIXTURES MECHANICAL FIXTURES
NO. 2.00 PER FIXTURE OR TRAP FEE FNO. TYPE_OF FIXTURE FEE
WATER CLOSETS 6 ,� FORCED-AIR/GRAVITY TYPE FURNACE
BASINS �00 FLOOR/SUSPENDED FURNACE $roe'BATH TUBS � BOILER/COMPRESSOR fee
SHOWERS I�,Q� REPAIR/ALTERATION �f
WATER HEATERS � REFRIGERATION COMPRESSOR SYSTEM ere@
AUTO.WASHER 09,00 AIR HANDLING UNITS e
SINKS HEAT-PUMPS 6.00
FLOOR DRAINS s EACH GAS PIPING SYS.2.00 PER OUTLET
DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT
.! LAUNDRY TRAYS WOOD STOVES 5.00
CONNECT TO CITY SEWER WOOD FURNACE �QQ
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 CERTIF HAT I AM A CURRENTLY REGISTERED
THE CONTRACT OR REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON CONTRACTOR IN THE STATE OF WASHI ON AND I AM AWARE OF THE ORDINANCE
COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL REQUIREMENTS REGULATING THE K 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 CONE MANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRS ,Jr,B.TAIN NG/AP"PPR VAL FROM THE BUILDING DEPARTMENT. q�1. WITHOUT FIRST OBTAINING PROVAL FROM THE BUILDING DEPARTMENT.
X OWNE1; 1X4,1 / f -ATE �� /" X BY DATE_
FOR OFFICE USE bNLY
APPLICATION ACCEPTED BY PLANS CHECK BY Tj
LDING GROUP APPF}C ED F R ISSUANCE PERMIT VALIDATION
;; "-1 -- II'\ -1 BY ��) -_ CASH CK MO