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Home My WebLink AboutBLD90-25454 - BLD Application - 4/12/1990 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO.'�`� NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER CR40T i -10AM n1 6 6 t3KPc SH A 4 WA 9g58q 4_L(0-5Z80 DIRECTIONS TO JOB SITE „� LO I�PoI� TO S t'AELTa OA i'��AT�-0 1. PARCEL LEGAL i� SuaJ ( cl LoT' `r ar SP �8S NUMBER 'I'al!'�`Z'�S ')OIO�j DESCR. "K4AbC _ AME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR ►1A(RKA 4otn-t • ej-� EUC-Lib USE OF E BUILDING P tgN�r�i' 'S�06LIE F1�t'n 1 2e5t)tTCE CLASS OF NEW `� ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE �� WORK r��j BEDROOMS_ S T NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS Z%L TRtSb�. T. GARAGE Z,�QXZO CONDITIONING. NO.OF STORI ES BASEMENT ATTACHED `Iw�- 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 TOTAL SQ.FT. > o FFR e-E D&TRE4E9 ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHARft#ME SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED 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 ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING PPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OWNE k DATE X BY— `Q .,AA. —DATE Z- — ya FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION �� 0 YES NO YES NO HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT Yl>c) D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION SHORELINE WOODSTOVE ,V� L PLUMBING Z C_j. CQ c� MECHANICAL ` STATE BUILDING FEE STATESURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY f OVE ISSUANCE PERMIT VALIDATIONen TOTAL `� B CASH CK MO PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER " 5 .1 sago DIRECTIONS TO JOB SITE i 1 Icy 1 I Rt 'L SS F i- A C Q LEGAL D SCR. 7Rgci' io sv. I 91 Ako kna ,'t a, L.� #'� aP 5Q IV50 CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE z6 S USE OF -- BUILDING �Qlk. MIL eAkg PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS 0 10 FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 SHOWERS REPAIR 1 ALTERATION 6.00 WATER HEATERS REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER AIR HANDLING UNITS 7.50 SINKS HEAT-PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKINGFOUNTAINS VENT.FAN SYS.3.00 PER UNIT ®_ LAUNDRYTRAYS 2- WOOD STOVES 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 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 CERTIFY THAT I AM A CURRENTLY REGISTERED THE CONTRACT OR REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON CONTRACTOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE ORDINANCE COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL REQUIREMENTS REGULATING THE WORK 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE X BY y�--DATE Z ' FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BYEaWLDING GROUP !BY R ED ISSUANCE PERMIT VALIDATION ` CASH CK MO PLOT PLAN ADDRESS PERMIT NO. o = s LEGAL ..02- 7S- oio3 o DESCRIPTION'9r io 5 `LOT#� gf j1' ISSt? BLK ADDITION SITE AREA k Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS I Ls�� Sq. Ft. INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. O Z INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' r �— PP OP166 f-® ev jPo AV 54 5 P I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. NAME(!) OF OWNER(!) OF SITE 6 STRUCTURE(S) (PRINT) iIGNATURE OF OWNER(!) OR AUTHORIZED REP EIENTATIVE DO NOT WRITE SELOW THIS LINE APPROVED DATE DISTRICT AS NOTED