HomeMy WebLinkAboutBLD29804 - BLD Application - 1/7/1992 PLUMBING & MECHANICAL PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of Gr_NERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAM MAIL ADDRESS n CITY&STATE ZIR. PHONE
DIRECTIONS
TO JOB SITE Z:,�, �' J ) _ 1=�0 )k�
LEGAL
DESCR. 1�✓ Cv E��C�s C�L� yG f
CONTRACTOR NAME MAIL ADDR SS CITY&STATE LICENSE NO ZIP PHONE
USE OF
BUILDING
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 FLOOR/SUSPENDED FURNACE 6.00
BATH TUBS BOILER/COMPRESSOR 6.00
SHOWERS REPAIR/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 4,
DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT
LAUNDRY TRAYS FIRE SUPPRESSION 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 L
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 I RMANCE THEREWITH. N CHANGES SHALL BE MADE WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST O NIN RO L H I G DEPART T. WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE X BY _ _ _ _ DATE_ _
F R OFFICE USE ON LY
APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION
IBY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON,COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 oar ISSUED
PERMIT NO.
NA E MAIL A00 ESS CITY d STATE ZIP PHONE
OWNER
DIRECTIONS
To ice SITE i /ice �tJ 6
PARCEL LEGAL /
NUMBER zlz� I OESCP. IdLr��� �.�/ rlJ� ✓/!� '� / /� �
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
+_ O Location of proposed construction on property.
�I O Building & septic system setback distances from all property lines 3 easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system"as built" or septic permit-approval.
-O Indicate topography profile of property and structure on reverse side.
A --I
= - - - I
Jet I .r_ _,
�r4
I/�VG CBKiry:hat tht�NCOS@�.COns:r jC:iCn wil:,:JnrJr1 to!me diTeeiSians and uses shown above and:tar no Changes,vill be rndde wir,`,Jut!ifs;Jbtair.ing d7vNvdl.
TOPOGRAPHY PROFILE OF PROPER T f AND LOCATION OF STRUCTURE
� f
r r r
'f T 4