HomeMy WebLinkAboutBLD29599 Remove Wall and Repair Bar - BLD Application - 11/21/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED/ �/
PERMIT NO.Ck/ Jf
E MAIL ADDRESS CITY ISTAT ZIP PHONE
OWNER
�P�JC a C2 0 , �j
DIRECTIONS
TO JOB SITE Q Q Q27,t [1, LIJ y 3
PARCEL LEGAL , l
NUMBER +- - DESCR. 117� I
A MAIL ADDRESS C Y&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDINGiounael
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK l 4141f - r .-4C Z �✓�% � �
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED 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
TOTAL SQ.FT. FI REPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONF HEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA G APPR VAL F M E BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X ER ATE a /_ X BY DATE__ _
A r
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING M FIRE BUILDING PERMIT `
D.O.T. BUILDING PLAN CHECK rj
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE _
A PL CAAII ACCEPTED BY I PLANt EC BY APPRO ED F�ISSUANCE PERMIT VALIDATION
/�� � BY 1 I,' CASH CK MO TOTAL
PLUMBING & MECHANICAL PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER
,.MX IL ADO SS ITY 3 STIyTE ZIP PHONE
/
DIRECTIONS
TO JOB SITE r C�� !✓
LEGAL
DESCR.
CONTRACTOR NAME MAILADDRESS CITY SSTATE 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 SY51EM 6.00
AUTO.WASHER AIR HANDLING UNITS 7.50
l SINKS HEAT-PUMPS 6.00
FLOOR DRAINS EACH GAS PIPING SYS.2.0 ER OUTLET
DRINKING FOUNTAINS VENT,FAN SYS.3.00 PE 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 0 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 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 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 FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE X BY DATE
FOR OFFICE USE ONLY
APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION
APPLICATION ACCEPTED BY PLANS CHECK BY 7
IBY CASH CK MO