HomeMy WebLinkAboutBLD95-00469 Drive Up Espresso - BLD Application - 4/4/1995 Permit No. Q 11
MASON COUNTY 2
BUILDING PERMIT APPLICATION
426 W. Cedar/P. . Box 186, Shelton, WA 98584 427-9670/1-800-562 6228 �pah pyb�l
PLEASE PRINT
#4'teity
iG Phone
a75- O
Address /✓ E ,2.2 S�f"1 i tl u/4 l/ 'S Fire D strict# .S
/3E`F.4i2 y t St A- Zip JEJ2_
Directions to Job Site jJ <ieoAf Z ill
EG /JELL .C� S'i E.
Owner Mailing Address Al, t>.
City St GlJ.4 Zip 9e5-, 9
Lien/Title Holder E T Gj JE A
Address
City St Zip
#2 Contractor Name /";;��".40"r 2"ew Contractor Reg# PlOWdeV
Address YF/� /P8 d ,4dE_ ��sT Expiration Date
City ZMIA�I;W 44" St j(eJA0ftW. Zip 98390 Phone# 30 - T3 Z o
#3 If septic is located on project site, include records.
Connect to Septic?,6�Q_Public Water Supply Well
Connect to Sewer System?_6& _Name of System
(If residential, proof of potable water is required)
#4 celNo./233� SC/ - O®/03 - d b/off
egal Description �R 43 N 7 6 Tie 9� %��Ea�s E 4 E&�
#5 Building Square Footage: (existing/proposed)
1st FI$_/ /�I 2nd FI / 3rd FI
Basement / Deck / #bedrooms / #bathro ms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Use of building ES Poe COFFEE ajrgV/ C- Describe work' .O.e dE - e
f 1�14� - eo FEc` SCxf/�c�
#7 Type of Job: New Add _Alt Repair lJ R D
#8 MOBILE/MANUFACTURED HOME INFORMATION APR 0 J1 iM
Model Year Make Model
Length Width Serial No. HEALTH ERVICES
#Bedrooms #Bathrooms Type of Heat
Purchase Price$
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other /V A
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Elect ic,
_Bath Basins Heatpump, Other `
Bath Tubs r14 Units
Showers _ Furn BTU
Hot Water Htr _ Heatpumps
_Laundry Washer Vent Systems
I Sinks 3 _ Spot Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins _ HP
Dishwasher Ngg, Air Handling Units
_Disposal _ cfm#
Urinals Imo, Fire Protection Syst ms
Other _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
J
TOTAL PLUMBING $ f�i '� Ng. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AMAWAREOFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATINGTHE WORK FOR WHICH THEPERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE N CONFORMANCE
CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FR M THE BUILDING
THE BUILDING DEPARTMENT. DEPARTAd�NT.
/ , /
X OWNER �1�1 /s/Lt X B G�
DATE DATE
FOR 61 FiC1AL USE ONLY:AoCepted b�:.. Date:.
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