HomeMy WebLinkAboutBLD92-1269 REROOF - BLD Permit / Conditions - 10/13/1992 k,.
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation
Floors Final
date FRAMING by date by date by
Walls FIRE DEPT.
date
PLUMBING by date by date by
Attic OTHER
Groundwork
date by date by
p W WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
- Permit NO.BLD
MASON COUNTY
'k BUILDING PERMIT APPLICATION
PLEASE PRINT
� i
#1 Owner__ )1(le',, Phone#
Site Address I 3 9141
`=
City r°� >> ) St Zip 9' e.5
Directions to Job Site
Owner Mailing Address Id-3
City St W Zip
Lien/Title Holder
Address
City St Zip
M #2 Contractor Name
Contractor Reg#
Address -Axpiration date
City -St—zip Phone
#3 If septic is located on project site, in Jude records.
Connect to Septic?_ Public water S' pply well
(If residential, proof of potable water may be required)
#4 Parcel No. _� .➢'°; �. � �/ �y
Legal Description (Q
#5 Building Square Footage: (existi.nq/propose' )
1st Fl / 2nd FI / 3rd F1 Loft /
Basement / Deck / #bedro Mg
#bathrocros_�_
Garage Carport / (Ciro : Attached or Detached?)
Other sq ft /
#6 Use of building - -
Describe worker
#7 Type of Job: New Add Alt � pair Demolition
Woodstove Re-Roof Bulkhead Other
#8 MOBILE H0-NE INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: sa twater lake
river pond wetland s ascnal runoff
No. Toilets Vent Systems X 3 . 00
Bath Basins Vent Fans X 3 . 00
Bath Tubs No. Boilers/Compressors
Showers 0-3 HP 6 . 00
Hot Water Htr 3-15 HP 6 . 00
Laundry Washer 15-3 0 HP 6 .00
Sinks 30-50 HP 6 . 00
Floor Drains 50 + HP 6 . 00
Laund
ry Basins No. Air Handling Unit
Dishwasher <- 10000 cfm. 7. 50
Disposal > 10000 cfm. 7 . 50
Urinals Other
Other Evap Coolers
Hoods
Permit Basic Fee 3 .00 Fire Suppression
TOTAL PLUMBING $ Domes. Incin.
Comml. Incin.
Reloc/Repair 6 . 00
Mechanical Fixtures Gas Outlets X 2 .00 ,
No. Fuel Types Woodstove separate
Furn < 100K BTU 6 . 00 Other j
Furn >a 100K BTU 6. 00
Furn - Floor 6. 00 Permit Basic Fee 10 . 00
Heat Pumps 6. 00 TOTAL MECHANICAL $
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 ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AN EXEMPT FROM THE REQUIREMENTS OF THE .I CERTIFY THAT I AN A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AN AWARE IN THE STATE OF WASHINGTON AND I AN AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WNICN 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 CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
CX OWNER d�'t--y tea_ �. ��x �' -� X BY
DAIS DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
FOR OFFICIAL USE ONLY: Accepted by Date
E I� Show following 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:
APPLICANT TO DRAW SITE PLAN BELO
e
PLICANT TO DRAW TOPOGRAPHY PROFILE BELO
r:i r t 1y1 ;1 1 IA_L ,, r, V 11,VV
FOR OFFIc$ USE ONLY - -
1
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Approved Coed Holt!
Approval
Planning:
P
Environmental Health:
Building Plan Review: -
Occupancy Group:
Fire Marshall:
Other:
IISPecial Conditions: it Ilsite InspectionEs I I
�� Il i I
II II IlBuilding Permit IG li
II II 1 I
II II IlViolation Fee I II
II II I I
II II IlViolation Investigation Fee I II
!1 II I
li 11 Plan Check I II
II II I 1 I
II II Plumbing Fee ► II
II II I I
II II IlMechanical Fee I II
II I
�� II IlWoodstove Fee I II
II II I I
I� II IlBuilding State.Fee I
IlBuilding 'valuation: /5� I! II TOTALI II
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