The URL can be used to link to this page

Home My WebLink AboutBLD1729 Addition - BLD Application - 4/17/1975 BUILDING PERMIT APPLICATION MASON COUNTY P. O. Box 400 Shelton, Washinqton 98584 DATE _� ?s n D Applicant to complete numbered spaces only. PERMIT NO. u JOB ADDRESS N o c v LESGAL. .� o L LL e- to Z DE CR �NE/y f *� � ��(� � .....RED ..... WNI 1 S OWNER MAM ADORES PHONE CONTRACTOR MAIL ADDRESS PHONE LICENSE NO, ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. 4 ENGINEER MAIL ADDRESS PHONE LICENSE NO. 5 LENDER MAIL ADDRESS BRANCH 6USE OF BUILDING✓ 7 PG / fE� G / G O�CY G-ice 8 Class of work: ❑ NEW 2�-AODITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE 9 Describe work: /-ell 3 Z— fW D rC o o ► -\ a 1-4 ,4 a 4-C,�,, 9__K r S —4 �r 10 Change of use from Change of use to 11 Valuation of work: $ r�'S� ) cV PLAN CHECK FEE PERMIT FEE 3� SPECIAL CONDITIONS: Type of Occupancy Const. y Group Division Size of Bldg. IbX 3 Z No.of Max. (Total)Sq. Ft. Stories Occ. Load Fire Use Fire Sprinklers APPLICATION ACCEPTED BY. PLANS CHECKED BY. APPROVED FOR ISSUANCE BY. Zone Zone Required ❑Yes ❑No ---- No.of OFFSTREET PARKING SPACES: Dwelling Units Covered Uncovered N O T I C E Special Approvals Required Received Not Required ZONING SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT. AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Soecify) TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. SIG A URE OF CONTR C R O AUTHORIZED AGENT I (DATE) SIGNATURE OF OWNER IF OWNER BUILDER (DATE) PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH SHEL.TON PRINTING C.. W7 PLOT PLAN ADDRESS r/ �� y �� l V \� PERMIT NO. J� 9 0 — f o = a D LEGAL I DESCRIPTION LOT BLK ADDITION c/ C SITE AREA V l/�� O Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 6 Sq. Ft. \ INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE ^' FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) W FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. ° 1 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' 5 4 C rK C \` \ � 3 ,I s I/We certify that the proposed construction mill conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. NAME(S) OF OWNERIS) OF SITE 6 STRUCTUREISI (PRINT) SIGNA RE OWNERS) O A THO 1 ED RE RESEN TA TIVE DO NOT WRITE BELOW THIS LINE APPROVED I DISTRICT AS NOTED DATE //J/J_� 6HEL-ON PRINTIN3 - i..lil 1 Permit No. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 PLEASE PRINT#1 Owner R i j- Re l T� Phone# 2 7 5--- z SlC Site Address /j 3 9'�c / lac / -3 City —e > St w Z. Zip 5� Directions to Job Site Owner Mailing Address 3 3 o 7 s L z- City c w, c.- T a St I^1 z Zip Lien/Title Holder N-f Address City St Zip #2 Contractor Name Asa Nl L�'3 s 7- T Contractor Reg. # Address Z Y z✓ Z 5-G z b K 1-/w ,/ Expiration date �f y/ c/ / City %3 P c -- r o St LO z Zip 1 Q3 i z Phone 3 7- -1 6 #3 Parcel No. 2 3 z Ir - `/ / -as 9i o d Legal Description N C 2. 3 t 1-f #4 Use of building Describe work T, o v� #5 Type of Job: New Add Alt Repair Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. LLaLFees _Showers Furn BTU _Hot Water Htr Heatpumps _Laundry Washer — Vent Systems _Sinks Spot Vent Fans Floor Drains _ No.. Boilers/Compressors Laundry Basins HP Dishwasher \ No.. Air Handling _Disposal _ cfm# _Urinals N4_ Other _Other _ Gas Outlets Wood, Gas, Pellet Stove Permit Basic Fee 15.00 TOTAL PLUMBING $ Permit Basic Fee 15.00 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 any time after work is commenced. Proof of continuation of work is by means of a progress inspection. NOTE: If this permit application includes the placement of a fuel tank, heat pump or other unit to be located outside of the existing structures, a plot plan MUST be submitted as required below: Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems, Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRAC- THE CONTRACTORS REGISTRATION LAW RCW 18.27,AND AM TOR IN THE STATE OF WASHINGTON AND I AM AWARE OF THE AWARE OFTHE MASON COUNTYORDINANCE REQUIREMENTS ORDINANCE REQUIREMENTS REGULATING THE WORK FOR FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE SHALL BE MADEWITHOUT FIRSTOBTAINING APPROVAL FROM WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. Q X OWNER X BY.��/o—,�-.�— DATE DATE -;�' 3 Return permit to: Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670/1-800-562-5628 FOR OFFICIAL USE ONLY: Accepted by: Date: Receipt No. Referred To DEPARTMENTAL REVIEW Proposal Proposal FOR OFFICIAL USE ONLY Approved Denied Planning: Building: Fire Marshal: