HomeMy WebLinkAboutMIS92-0144 Storage - BLD Application - 12/8/1992 %� D Permit No.BLD
D[:C 0 u 1992 MASON COUNTY
QUILDING PERMIT APPLICATION
PLEAS9 PR
ENfINRAL SERVICES
Z#1 Owner Phone#Z T ;�d
Site Address /3i Teo e e, /��110 !C- 4Jo IZ52 J
City State 't)4. Zip
Directions to Job Site ke d aev
a
Owner Mailin Address U
City r 1 State /a(//c Zip 6
Lien/Title Holder S (-4-171
` Address
City State Zip
#2 Contractor Name Contractor Reg #
Address Expiration Date
City State Zip Phone
#3 If septic is located on project site, include record
Connect to Septic? Public Water Supply. 1z
Well
(If residential, proof of potable water may be required. )
#4 Parcel No. ' a--:)- <�- 00')
Legal Description I
#5 Building Square Footage: (existing/proposed)
1st F1 / 2nd F1 / 3rd F1 / Loft T
Basement / Deck / #Bedrooms / .') #Bathrooms
Garage / Carport / (Circ e: Attached or Detached?)
Other sq ft
#b Use of building ���C�_� � 11 �� , Describe work )) C,�_�i l �_,.
#7 Type of Job: New Add Alt Repair Demolition
Woodstove Re-roof Bulkhead Other (75-c-LD
#8 Mobile Home Information
Model Year Make Cd D0�- Model
Length 11A Width "Z4 Serial No.0� /Zip/ qel) , y/
#Bedrooms #Bathrooms 2 Type of Heat
#9��i y water on or adjacent to property: Saltwater Lake River
Pond Wetland Seasonal runoff Other
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PlumbincT Fixtures ($2 . 00 each) Fee: No. Boilers/Compressor Fees-
No.-Toilets 0-3 HP 6.00
-Bath Basins 3-15 HP 6.00
Ba Tubs 15-30 HP 6.00
Shower�, 30-50 HP _ 6.00
Hot Water Htr 50 + HP 6.00
Laundry Washer
Sinks No. Air Handling Unit
Floor Drains « 10, 000 cfm. 7.50
Laundry Basins > 10, 000 cfm. 7.50
Dishwasher
Disposal Other
Urinals i;vap Coolers
Other \ Hoods
Fire Suppression
Permit Basic Fee 3.00 Domes . Incin.
TOTAL PLUMBING $ Comml . Incin.
Reloc/Repair 6.00
Mechanical Fixtures Gas Outlets x 2 .00
No. Fuel Types Woodstove separate
Furn < 100K BTU 6.00 Other
Furn >= 100K BTU 6,00
Furs - Floor 6.00 Permit Basic Fee 10.00
Heat Pumps 6.00 TOTAL MECHANICAL $
Vent System x 3 .00
Vent Fans x 3.00
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR C=STRUCTION
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 CONTRACTORS AFFIDAVIT
I certify that I am exempt from the requirements of the I certify that I am a currently registered contractor in
contractors registration law RCW 18.27 , and am the State of Washington and I am aware of the
aware of the Mason County Ordinance requirements for ordinance requirements regulating the work for which
which this permit is issued and that all work done will the permit is issued and all work done will be in
be in conformance therewith. No changes shall be conformance therewith. No changes shall be made
made without first obtaining approval fr m the Building without first obtaining approval from the Building
Department. j , Department.
X OWNER X BY
DATE: DATE
Return permit to: Department of General Services 426 W. Cedar Street/P.O. Box 186
Shelton, WA 98584 427-9670/1-800-562-5638
FOR OFFICIAL USE ONLY: Accepted Date: i`�'
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
AW-d
P 1 arning:
Environmental Health:- Fo P, -
Building Plan Review:_ J;4k L
Occupancy Group:
Fire Marshall:
Other:
FEES
Special Conditions:
IBu
ite Inspection
ildin PermitViolation Fee
Violation InvesticTation Fee
Plan Check
PlumbincT Fee
Mechanical Fee
Woodstove Fee
Buildinq State Fee
Building Valuation:
TOTAL
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