HomeMy WebLinkAboutBLD93-0914 Addition - BLD Application - 4/21/1993 Permit No.BLD
MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner S Phone#
Site Address Ct391 E , 4j6 +E W S I D
City I St U)R, Zip_ �g 5qz-
Directions to Job Site
M L1- S ll) TL�1 A 1J l�-a S tom`
Owner Mailing XA
dress .D.
city iL21-A St Zip Z
Lien/Title Holder
Address UW E
City St Zip
#2 Contractor Name Contractor Reg#
Address Expiration date
City St Zip Phone
#3 If septic is located on project site, include r cords.
C;nnect to Septic? _ Public Water SuppiyZo Well
(If residential, proof of potable water may be required)
#4 Parcel No.32-Z 3 5" -S r - G o o p :f:f
Legal Description ::r&� q k)II-lig l S HuRPki R130K 1)T Rn,
45 Building Square Footage: (existing/proposed)
1st Fl / 2nd Fl / 3rd Fl / Loft /
Basement Deck / #bedrooms_� ( #bathrooms_
Garage / Carport / (Circle: Attached or Detached?)
Other sq ft /
hI� �
#6 Use of building L el Describe work (1C,[A
,�7 Type of Job: New Adds_ Alt Repair Demolition
Wocdstove Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length_ Width Serial No.
#Bedrooms #Bathrooms Type of Heat
9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
'I other
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
dN �11Df I lib .
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
,wing Fixtures ($2 each) Fee Fee
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 15-30 HP 6 . 00
Sinks 30-50 HP 6 . 00
Floor Drains 50 + HP 6 . 00
Laundry 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 PLUP�IBING $ _ Domes . Incin.
Comml . Incin.
Reloc/Repair 6 . 00
Mechanical Fixtures Gas Outlets X 2 .00
No. Fuel Types Woodstove segarate
Furn < 100K BTU 6 . 00 Other
Furn >- 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 ANYTMdF. AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFF=Vrr
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AN AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH 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.
r
X OWNER X BY
DATE DATE
'.eturn permit to: Department of General Services
26 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW log
FOR OFFICE USE ONLY
Approved Cord Kvld
Approval
Planning:
Pr j
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshall:
Other:
FEES
IlSpeci.al Conditions: 11 llsite Inspection I II
11 11 li
11 11 IlBuilding Permit ( II
II 11 R i (
II 11 11violation Fee I II
II II H I
II 11 1(violation Investigation Fee 1 it
II II C ;(
II- 11 llPlan Check I II
II II 1i
II 11 IlPlumbing Fee I II
11 11
11 11 11Mechanical Fee I II
11 11 IlWoodstove Fee ( 1l
II 11 11 --il
11 11 1Building State Fee 1 11
1' 'I I; 'I
IlBuilding Valuation: 11 11 TOTA,I II
l It I �