HomeMy WebLinkAboutBLD93-0053 Cancelled Propane - BLD Application - 3/25/1994 Permit No.BLD
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
PLEASE PRINT 2LDq'— oo��3
#1 Owner Phone# o� ,
Site Add Tv';=t-3
City St b✓^ Zip 99�3/Z
Dire tions to Job Site ��vD Q.:c F J�-/J ,t��•9+e-
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Owner Mail ' g Address .d. ok
City 2;L kL-"Aly/ h St Zip -3/Z
Lien/Title Holder
Address
City St Zip
#2 Contractor Name C(n� Reg#
Address ) - Ex date
City t ip op
#3 Parcel No. /Z3 -
Legal Description
#4 Use of building (,� De%re work
i -�-
#5 Type of Job: New .,�Add Alt Repair Demolition
Plumbing Fixtures ($2 each)
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 -PLUMBING $ _Domes. Incin.
Comml. Incin.
Reloc/Repair 6. 00
Mechanical Fixtures Gas Outlets X 4?.00
No. Fuel Types Woodstove separate
-_LFurn < 100K BTU 6.00 Other
Furn >- 100K BTU 6.00
Furn - Floor 6 . 00 Permit Basic Fee
Heat Pumps 6. 00 TOTAL MECHANICAL $
If this permit application includes the placement of a fuel tank, a site plan _
indicating lot dimensions, existing structures, structure setbacks, septic `
systems , and easements MUST be attached.
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION A=ORIZED 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 AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF W►SHINGTON 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 06TAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
V
_E
FOR OFFICIAL USE ONLY: Accepted'. by: Date.
Approved Cond Hold
DEPARTMENTAL REVIEW - for office use only Approval
Planning:
Building Plan Review:
Occupancy Group :
Fire Marshal :
FEE
Special Conditi ns : CL :Q� fy1 L Plumbing Fee
C'�nd�.` i�►yc�AiS �
Mechanical Fee
Other
TOTAL
Valuation:
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 BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
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Permit No.BLD
MASON COUNTY -
BUILDING PERMIT APPLICATION
PLEASE PRINT ,
#1 Owner Phone#
Site Address
City St Zip
Directions to Job Site
Owner Mailing Address
City St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name Contractor Reg#
Address Expiration date
City St Zip Phone
13 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water may be required)
-4 Parcel No. -
Legal Description
5 Building Square Footage: (existing/proposed)
Ist Fl / 2nd Fl / 3rd Fl / Loft /
Basement / Deck / #bedrooms _ #bathrooms_
Garage / Carport / (Circle: Attached or Detached?)
Other sq ft /
=6 Use of building Describe work
7 Type of Job: New Add Alt Repair Demolition
Woodstove Re-Roof Bulkhead Other
3 MOBILE HOME INFORMATION
Model Year Make Model
Length_ Width Serial No.
#Bedrooms #Bathrooms Type of Heat
n9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
i
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg.III 426 W.Cedar
P.O.Box 186 Shelton,Washington 98584
(206)427-9670
BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
December 28, 1993
RE: Permit # 1a)L
Dear mom,
On / 9/ 93 , this office approved for issuance the above
permit number. Pursuant to the Uniform Building Code, Section 304,
this permit, once approved for issuance, must be issued within 180
days to stay valid. Failure to pick up the permit within the 180
day time frame will void the permit and it will be necessary for
you to re-apply for the permit thus, meeting all new review
requirements.
Further, the Uniform Building Code, section 304 allows for the
collection of the plan review fee if a plan review has been
performed and the permit cancelled. In the event that you no
longer require the permit or choose to cancel the permit, the plan
review fee due on this permit is $ The check or money
order should be made payable to the Mason County Treasurer and
submitted to this department for processing. Once the plan review
fee is paid, we will return the plans to you and cancel the permit
request.
If you wish to obtain your permit now, the amount due for your
building permit is $ a-1 . (am. Once received, we will issue
the permit, either in the office or we can process the issuance
through the mail . The permit will remain valid for a period of 180
days . At the end of this 180 days, an inspection will be required
or a one-time only extension can be granted through letter request
however, all future extensions must be granted by progress
inspections .
Please respond to this notification prior to January 17, 1994 .
Sincerely,
QNVO � ay-)
Cheryl Ra an
Building Department
(206) 427-9670
cc: Property File