Loading...
HomeMy WebLinkAboutBLD93-1321 Beauty Salon - BLD Application - 8/14/1993 Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owne ZZ-Q GvL✓ri!ca-1^ Phone# -7 7 -77 7317 Site Address Fire District# -21 Cit a-ZlJ St Zip Directions to Job Site ¢� OwnerA4§tiling Address -7 / -sP City i C,'� St Zip Lien/Title Holder Address City St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of Sys em (If residential, proof of pota67e water is required) #4 Parcel No - - > Legal Description #5 Building Square Footage: (existing/proposed) 1 st FI 76 O/ 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building Describe work -HG.ti #7 Type of Job: New Add—S� Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make Model Length Width Serial No. #Bedrooms # Bathrooms Type of Heat Purchase Price$ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff 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 Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW I hAft"aO ShNryIPa, c V O ?J� J� T� 1 wk t=lrs I APPLICANT TO DRAW TOPOGRAPHY PROFILE BE OW Q �p(o RAO Pj P-'- Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Units Fees Showers Furn BTU Hot Water Htr _ Heatpumps _Laundry Washer Vent Systems Sinks (0 bd _ Spot Vent Fans 1 Floor Drains 3 ©`� No.. Boilers/Compressors _Laundry Basins HP Dishwasher No.. Air Handling Units _Disposal _ cfm# Urinals No... Fire Protection Systems Other _ Auto. Fire Alarm Sys 50�00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ �.}.Q� . Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNE �•-��'�`'�`— X BY DATE 77 DATE LFOROFFICIAL USE ONLY: Accepted by: Date:— __---- - _- - _ - - --- - _.-I �J DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES o0 Building Permit Plan Check Plumbing Fee c f. 00 Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee e0 Nc� v�+u D f2� �j-. Site Inspection $ Building State Fee Other Other Building Valuation: TOTAL FEE y1q. 5-0