HomeMy WebLinkAboutBLD93-0677 Rebuild Covered Drive-Thru - BLD Permit / Conditions - 7/6/1993 r z -
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas?iping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Wall;; FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
q 'n
PLEASE PRINT � � tJV
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} #1 Owner �.L /�/U/C f r%I` c o Phone# �g
Site Address i. " ' �_ /f��� «' Fire District #
City (� . g� / St - . "F Zip
Directions to Job Site /t'
Owner Mailing Address
City St Zip
Lien/Title Holder a
Address
City St Zip
#2 Contractor Name Contractor Reg#
Address Expiration date
City r,; St Zip / Phone
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water is required)
y4
#4 Parcel No. i 5n I
Legal Description
#5 Building Square Footage:
1st Fl 2nd F1 3rd Fl Loft Basement
Deck #bedrooms #bathrooms Garage Carport
Garage/Carport: Attached or Detached
Other
#6 Use of building ,` Describe work
#7 Type of Job: +'New Add Alt Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
Show 2olloving on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date: c;
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
Plumbing Fixtures Fee Mechanical Fixtures
No.__Toilets Primary Heat Source (drele type)
Bath Basins Elect/heatpump/other
Bath Tubs
Showers F�F�
Hot Water Htr Furn
Laundry Washer Heat Pumps
Sinks Vent Sys (Central)
Floor Drains Vent Fans (Spot/Whole)
Laundry Basins Boilers/Compressors
Dishwasher HP
Disposal Air Handling Unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee
TOTAL PLMMING $
Other
Gas Outlets.Hookups
Wood/Pellet/Gas Stove
Other
Permit Basic Fee
TOTAL MECHANICAL $
NOTICBs 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 ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAY RCW 18.27 AND AM AWARE IN THE STATE OF WASHINGTON AND I AN 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. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANCES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, NA 98584 427-9670/1-800-562-5628
FOR;08 .... : SY .ONL]t; Ac p E by Dtg,
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cod Hold
Approval
Planning:
Environmental Health:
Building Plan Review: f
Occupancy Group:
Fire Marshal:
Other:
FEES
Ilspecial Co ti o5t: II IlSite Inspection ( II
II L -II
II II IlBuilding Permit
II II I I
II 11 11violation Fee I I�
II 11 I' 'I
II II 11violation Investigation Fee I ii
II II I I
II II II Plan Check
II 11 1 I
II II II Plumbing Fee
II II I I
II II IlMechanical Fee
II II 1 I
II 11 Ilwoodstove Fee I II
II 11 1 I
II 11 IlBuilding State Fee
I I I
IlBuilding Valuation: 11 11 TOTAL I II