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BUILONG PERMff APRICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME N L ADDRESS CITY 3 STATE ZIP PH NE
N
DIRECTIONS
TO JOB SITE
LEGAL '/ (❑SEE ATTACHED SHEET)
DESCR. LOT GI //� .,' LA/v� J/1111�6Cr LL
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. - 7.
CONTRACTOR f10
USE OF
BUILDING 0040"GL/A
Class of work: KNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: S p PLAN CHECK FEE PERMIT FEE O d
.
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT❑ S�g NOTICE
BATHROOMS 1- TOTAL SQ. FT. GARAGE OpSEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES :BASEMENT ❑ ATTACHEDJ9 OR AIR CONDITIONING.
TOTAL SO. FT -3 FIREPLACE ❑ DETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT ,--J IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
e d 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 FO OFFICE U.�E ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT V SHORELINES
19
SEASONAL ❑ FLOODPLAIN ❑
Firm S�,I-�, 'S�.✓_S G.OiLES+R�-� T'/Oi✓ E.D. NO. S.E.P.A. ❑
BY r Special Approvals IN OUT YES APPROVED
NO
Lic. No, TGI l97.,V5 Date ZONING
41 'IF PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.,
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conjormance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. 1 QQ BY
P . CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O.BOX ise Shelton,'Washington 98564
PLUMBING PERMIT APPLICATION.
IMPORTANT-Complete ALL items.Mark boKes where applicable.
Name Mailing address—Number,street,city,and State Zip code Tel.No.
t. / sdP /f� /�i� .'/ /� a3
Owners IC�/l7iE /✓ l�Iq Tr �OdWAN
2.
Contractor
The owner of this building and the undersigned agree to conrorm to all applicable laws of Mason County and State of Washington
signature or. I Address f�/fi Al.j f�'A�aV 1jr /L• Application date
01
LEGAL IDWORIIPTf
L/��cE"L err Y 1G
Location
Of
Building
NO, PLUMBING FIXTURES FEE
WATER CLOSETS - .4 D
BASINS b O
BATH TUBS Q a
SHOWERS O U
WATER HEATERS 6
AUTO.WASHERS O d
SINKS ,Q
FLOOR DRAINS
DRINKING FOUNTAINS
0 LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL D
URINAL
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT r O a SKETCH IN SEPTIC TANK 3 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by Permit fee Date pemit issued Permit number Rsoelpt No:
MASON COUNTY PLANNING DEPARTMENT
^" P.O.Box 188 SMalbn,,Washington 98W
. _..-! -
MECHANICAL,PERMIT APPLICATION
IMPORTANT-Complalke ALL items.Mark boxes where applicable.
1. LEGAL DESCRIPTION
Location slt or. L /l.La9 k4
Of N 5. N S
Building E W side of feet E w from intersection of
.
Sect. Twp. Range
NO. 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 Stu's,44.00 ALDO compressor over 50 horse power or each absorption system over
1,750,000 Btu's-25.00
2. Over 100,000 Btu's-$5.00
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-43.00
heater, or recessed wall heater-44.00 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-54.00
11. For each evaporative cooler other than portable type-43.00
6. Installation or relocation of each boiler or compressor to and
including 3 horse power--U.00 18, For each ventilation fan connected to a single duct-52.00
7. Over 3 horse power to and including 15 horse power47.50 19. For each ventilation system which is not a portion of any heating
8. Over 15 horse power to and including 30'horse power410.00 I or air conditioning system authorized by a permit-43.00
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's--$4.00 21. For the installation or relocation of each domestic type in-
cinerator-$5.00
11. Over 100,000 Btu's to and including 500,000 Btu's-=7.50
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 Allis
13. Over 1,000,000 Btu's to and including 1,750,000 Btu's Code but not classed in other appliance categories, or for which
-$15.00 no other fee is listed in this Code-43.00
Bask Fee $8.0 0
FIELD INSPECTION
rl"•D0
Date BY Remarks TOTAL
Name Mailing address -Number, street, city, and State Zio code Tel. No.
Owner
2.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of MASON COUNTY
Signature of applicant Address Application date
DO NOTWRITE IN THIS 5PAC - FOR OFFICE USE
Approved.by Permit fee Date permit issued permit number Receipt No.
. 0 4 & •1 - 9943
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