HomeMy WebLinkAboutBLD90-25388 REROOF - BLD Permit / Conditions - 4/2/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO. �75 �
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER I L flc� E. a1 tC Lhn - E4-IU N VJA. Cis5`i'[ yam" `lie;
DIRECTIONS
TO JOB SITE p } - T' la n 4 L xl -- 1.U QLc ")
PARCEL LEGAL
NUMBER p j z5vac DESCR. �A-2K vwt-)D c'1 ZO
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR 1� p
1 � a• Cox 85i �_ � %� !( 3 �`a7-:�C ! 4
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE --
WORK ✓ li ...
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED 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. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT '' SHORELINE
SEASONAL
OWNERSAFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAI, 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 APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FRO �HE BUILDING DEPARTMENT. i
X OWNER DATE X B o 21 DATE /G
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO 4
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT P �� v6
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE L - .
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE P ERMIT VALIDA'JI
�J
B 1I�ASH CKl MO TOTAL - }
16
- �� rermarvo.
MASON COUNiY
t19V .4 7199kUMBING/MECHANICAL PE IMIT APPLICATION
aA` RVICE 426 W.Cedar/P.O. Box 186,Shelton, 98584.427-9670
#1 Owner Phone#
Site Address
City St w(-t- Zip c ;
Directions to Job Site i G'1 t fW n hC- F f- � L
i si a nd L 2 J�d . 1 ( e C' FG-r"i!" LGLne .
Owner Mailing Address
City St Zip
Lien/Title Holder
Address --
City St Zip
#2 Contractor Name `���� C` Contractor Reg. # -mod
Address Expiration date 1G
City St Zip 4 t Phone 4`5(D-4 G 5Cp
#3 Parcel No.
Legal Description
#4 Use of building Describe work .�
U-Lo C-0 ar 11144 44 vCLL.
#5 Type of Job: New Add Alt Repair �J { � � '� ✓
Plumbing Fixtures ($3 eachl. E0
ni I Fixtures each)
No._Toilets CIRO LE FUEL TYPE: Electric,
_Bath Basins Heat pump, Other ILLf t1 Cj
_Bath Tubs DO ka EM
_Showers — Furn BTU
_Hot Water Htr Heatpumps
_Laundry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains V_Q_ Boilers/ComRressors
_Laundry Basins _ HP
_Dishwasher big. Air Handling Units
_Disposal _ cfm#
_Urinals her
Other ._ Gas Outlets
_ Wood, Gas, Pellet Stove
Permit Basic Fee 15•� _
TOTAL PLUMBING
-- -- Permit Basic Fee 15•�
TOTAL MECHANICAL ��
NOTICE: This permit becomes null and void If work or construction authorized Is not commenced
within 180 days or H construction or work Is suspended or abandoned for a period of 180 days at any
d=gfW work is cexnrns V@d.Proof of o wWwatlon of work Is by means of a proms inspsdion.
v
IP UJt 011W U"K to tM t{,rt,4"*0
yt.rsrioe Of; 0 existing si'rt i r(M a Plot Plan MUST 6_@ submitiedas required below:
Show folfowirtg on the sh plan bell w:',at D(mensions, Existing Structures, Stnxxure Sedmdcs, Water Lies,Septic Systems.
Hood Zones,Weft Showines, Easements` Name of Flanking a Fronting Streets.Indkate directional by N. S,E.W,eta
I
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRAC-
THE CONTRACTORS REGISTRATION LAW RCW 18.27,AND AM TOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
AWARE OF THE MASON COUNTY ORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOR
FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
I-HE BUILDING DEPARTMENT. DEPARTMENT.
C OWNER X BY
)ATE DATE
leturn permit to: Department of General Services
26 W. Cedar/P.O. Box 186, Shelton, WA 98584 . 427-9670/1-800-562-5628
OR OFFICIAL USE ONLY: Accepted by: Date.
aceipt No. Referred To
DEPARTMENTAL REVIEW Proposal Proposal
FOR OFFICIAL USE ONLY Approved Denied
'tinning:
1
'Iding:
Marshal: