HomeMy WebLinkAboutBLD92-0585 SFR - BLD Permit / Conditions - 8/19/1992 : MASON COUNTY PERMIT
MCtSOn County Bldg. IiI 4261M. Cedar NULL & VOID BYE RATION
P.O. Box 186 Shelton, woshln�,48,5�4
DATE / BY
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Name of FrOat:L=g S>::.eet
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Date:
PLICANT TO DRAW MpOG—AAp=v PBAFILr'.. BrT
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'C:1 _8 0 OA-S, OR ;: CONS7.13TJCT-70N OR WOR.Q:S Sv5P== OR F,3ANDpN,,.7 ?CR A �r- rJD =.2 -OF 180 DAYS A: A ' , -^ZR ;,dOR_�_S COM*—C -
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t atTIFT r!K?1i.um EXEpwT FjCM TuE KMII0t6ITS OF Ti[E I �tTI�T MAT t AN A Q�REkTC7 REGI
CMITACTORS�LISTRATjai lrW RCY T$.ZT AMD AN AYARE STERB aWTRAC,-M
OF TTIE NI►S>]II C7JI/ ORDI IN THE STATE OF WASNIIIC7M AID I AN AW"E gF THE
/�' IUMCE REOUIMIEM F(M wmICt OWIMAMCE REOUIte"TS REQX ATING TIM WORD FCR WMICt
THIS ru ma-iS M2M AND TUT ALL UM 0=1 WILL RE IX
=NFORPAAKZ TIIEREHITN. IIDK*al T]IE ►K" IT ISSIiET7 AMD ALL VaC OOQc WILL RE IN
WIr%MT FIRST =TAIIIING ArmMAL qtM THE Ca1F�11AI10E TMEti<VIT1• ND �S =A" 6E Mae
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Retu= pe-4 t to: Depaxt=e.,t of General- Services
426 W. Cedar/P.O, g� 186, Sheltca, WA 98584 427-9670/I-800-562-5628
FOR_ O ONLY: _ -• _ - �r�--
Accepted by: - - Date: -<:..� ... . .
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I
PLUMBING & MECHANICAL PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDARIP.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY d STATE ZIP PHONE
OWNERZgw . .o, o A 833
DIRECTIONS ?1+1 -
TO JOB SITE ,3 )�(/. /1� Q ' 6 Q.
LEGAL
DESC R. L-OT-SLt O I Ll, (� L.J�T' D �-- $ °� IOLMEQ
CONTRACTOR NAME MAIL ADDRESS CITY STATE LICENSE NO ZIP PHONE
LC0A1kR'o &LAt'%.) s6q:5 lmpmML Why s-L-7 , eu'QV_*" Uj 244 -(off
USE OF
BUILDING 1$Sl
PLUMBING FIXTURES MECHANICAL FIXTURES
NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE_OF FIXTURE FEE
WATER CLOSETS FORCED-AIR I GRAVITY TYPE FURNACE 6.00
BASINS FLOOR I SUSPENDED FURNACE 6.00
BATH TUBS BOILER/COMPRESSOR _ 6.00
SHOWERS REPAIR I ALTERATION 6.00
WATER HEATERS Z. REFRIGERATION COMPRESSOR SYSTEM 6.00
AUTO.WASHER 2 AIR HANDLING UNITS 7.50
SINKS HEAT-PUMPS 6.00
FLOOR DRAINS 2. EACH GAS PIPING SYS.2.00 PER OUTLET
DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT
LAUNDRY TRAYS 7i 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
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 REOUIREMENTS 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 IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. WITHOUT RST OB IN PPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE X BY DATE
FOR OFFICE USE ON Ly
APPLICATION ACCEPTED BY PLANS CHECKBY� BUILDING GROUP A ED ISSU PERMIT VALIDATION
�```` g CASH CK MO
f }
MASON COffN';'. -
B=DLNG PERMIT APPLICATION
POISE PRINT
Site Add-es� •is
Owne_'- Address_ �•o•B to�c, St Zia�B`
Lie3/Ti rle Holder C" St 1A Zips_
Address City St
:Z Caa=acror Name A S Caaz+aC
Address o
c9t) - Z�
Cityyg,��,¢- paa date
St Z.i �-1 15 /9 g
PPttoae 275'-3l 0Co
3 If septic is located on project site, i.IIclude records_
Cnaaecr to Septic?-,X Public Water Su=ly We?l
Parcel No. 1 a�
Legal Des=iptinn Lo r v. VOL. p
L lAr-
Bu.zl S e Foo rage: (e�sr�g/pr�posedJ
18(,� 1st F1 F1 / 3rd FI Lott /
Basement ' Deck B,MT I Sly :bedz-oams / '.� wba Lsrooms_ G ge or
(GAR (s�l2 Otter sq
:6 Use of boil dirg AeSIDE XA-
At7 Type of slob New,_4_ Add Al t Rena;r . Demo.ii t_ion
Plumbing OcZy Ifer--oTaaical Chziy woodstave Omer Re-Roof
Bid_
�8 07 L=tbing F•ac-UZ:e
No. tubs No.• Sbel 1)rpes NO. Air HA=cU ;n9 M:i is {
Fu= < 100$ Z= 10000 �_ I
Furs >•• 1002C BTIT 10000 C±m.
Ba tti basiB.s F= Floor O
tbor
�S.i.aks Heat Pins '
_,L Dishwasher ___.gip Cool9=S
ve=t Sys_4= Hoods !
LSot Water Htz �= vent Fans
t Lau=dry Washer Bad //Compressors Ca o L. 2acia. '
,Floor Dra.ias
Re_ C/Repa�tr
3-15 RP Gas Qu tl a is ;
r J1 15-30 FP Woodstove
�I 30-50 FOP O=e_"' !7
50 + F�
dodel Year Make M_ode?
Le-^S=j_________ Wid: Ser_a1 No .
�Be-�-oores TBa�-oo�s
y'0
Y
.� AC water or or adjace_^^c co 0 oce==y: sal grace___,._ -lake
r_ver po:d we=-'a='' seasc:a_'
MASON COUNTY DEPARTMENT OF HEALTH SERVICES
POST OFFICE BOX 186
SHELTON, WA 98584
(206) 427-9670
FAX 427-8425
APPLICATION FOR DETERMINATION OF ADEQUACY
INSTRUCTIONS
1. complete Part 1. No determination can be made until Part 1 is fully completed.
2. complete only the portion of Part 2 applying to the type of water system utilized.
3. Submit completed application, with attachments to the health department for review.
PART 1: APPLICANT/PARCEL IDENTIFICATION
IIi#iisifiifiiil;#!if#!ffiifil!#ff':If#1#fiil':1'#:#ffi'fff##!!Iflifiif#!lit'iI!Ifilii!flf3#f!iff!I!Iffffi#'-.Iflflflfiifl![!iIl1!i#fliflf#flil11.=1llliftllllill!{!!1!I!l111111fif!
r
NAME OF APPLICANT S 5 EojWf4Sff-'f> DATE ` 2- Z
MAILING ADDRESS T-O TELEPHONE
K- W N t�526
C iCy ec�c.. Z1p
ASSESSOR'S PARCEL NUMBER
SUBDIVISION (If Applicable) I t/fSconl LOT B7 --
TYPE OF WATER SYSTEM (Check One) REASON FOR APPLICATION (Check One)
Public/Community Water System Building Permit, Single Family Res
Individual System, Drilled Well Building Permit, commercial
Individual System, Dug Well Building Permit, Replace/Remodel
Individual System, Spring Land Use Application
Name
Individual System, Surface Water Type
El Individual System, Other Other
PART 2-A: PUBLIC WATER SYSTEM
e„ �;i';iF6i' #...,. _ # llii'fiif' iii!!!!f#':f':':fffifRffiff!!iffi#Ili#!fli!i#!iH iflflil#fififi#flii!iflfff':"riff#
NAME OF WATER SYSTEM L 6c p I LLA16 WFI ID
`—� f`e water purveyor for this syste has previously filed a certificate of eater adequacy with the health
d'_st.:ct.
I am manager of trio above referenced waver system. The water system has DOA approval for service
connections, with connections presently in use. The applicant has approval to connect to this water
system. Service of water to the applicant for domestic purposes 1s consistent with both the water system
plan and the water right permit presently in effect. water lines are available to the applicant's property
line, or the applicant has made satisfactory arrangements to extend the lines.
S:511A7,;R:: OF SYSTL`7 mANAGER GATE
CONCRETE FNG WuL-L- PZOV104 MECHANICAL: MOBILE HOME
l�ooT I G pF1orG 5 `
FoowpBa, Setback date///A ?'a b Ribbons
date 'l r by Gas Piping date b
Foundad W tiai Walls J. 0 date � . b Set Up
y INSULATION date b
D" I F3 Insulation
date Floors Final
FRA4 by date by date by
date b Walls FIRE DEPT.
date //- �
PLUMBING y date by date by
Groundwork - Attic - OTHER
date 4 IN b by
D.W.V. WALLBOARD NAILING
date/ r7-, by date - by
Water Line FINAL INSPECTION
date by date by date by
6Allc0 4=v,e too71,t� Ha% /mgy 4/0 1ry Yn
-30-a2 i �
"A B
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