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Home My WebLink AboutBLD0518 SFR - BLD Application - 4/28/1987 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 to 1 I 426-5593 DATE ISSUED PERMIT NO. NA E MAIL ADDRESS CITY&STATE ZIP PHONE OWNERa DIRECTIONS TO JOB SITE ls+nz LEGAL DESCR. CONTRACTOR NAME AILADDRESS CITY&STATE LICENSE NO. ZIP PHONE � USE OF BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK BEDROOMS DECKS CARPORT NOTICE 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. GARAGE .- 0--V_ CONDITIONING. NO.OF STORIES BASEMENT ATTACHED r 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 TOTALSQ.FT. FIREPLACE ' DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME 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 REGIST TION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIR MENTS 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 CO FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAI ING APPROVAL FROM THE 46ILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. Af;X NE R DATE l X BY DATE FOR OFFICE USE ONLY PARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO IVEALTH PUBLIC WORKS FEE PLANNING L FIRE BUILDING PERMIT -324, QZ� D.O.T. BUILDING PLAN CHECK �g p Le) SPECIAL CONDITIONS BUILDING GROUP — 3 PRE-INSPECTION SHORELINE PLANNING PLUMBING ;7 '2 c n MECHANICAL STATE BUILDING FEE / G STATE SURCHARGE APPLICATION ACCEPTED BY I PLANSCQHEGK BY ' APPROVED FOR ISSUANCE PERMIT VALIDATION /� � � BY CASH CK MO TOTAL =1J PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 426-5593 DATE ISSUED l a PERMIT NO. ME MAIL DDRESS CITY, ESTATE ZIP PHONE OWNER J , a/f Gi �,f 5 1�' 7 DIRECTIONS TO JOB SITE A ZZ - / _ LEGALDESCR. CONTRACTOR NA M IL DDRESS CITY&STATE LICENSE NO. ZIP PHONE v x, ,S USE OF BUILDING PLUMBING XTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE WATER CLOSETS C C' FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS G, p p FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS p BOILER/COMPRESSOR 6.00 SHOWERS REPAIR/ALTERATION 6.00 WATER HEATERS p REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER C AIR HANDLING UNITS 7.50 SINKS o �. HEAT-PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT LAUNDRY TRAYS O C' WOOD STOVES 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISHWASHER c• 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 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 FIRS INING AP ROVAL FROM THE BUILDING DEPA TMENT WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE 1 / TOB X BY DATE FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION BY CASH CK MO PLOT PLAN _ADDRESS y �J�-) '�� 9Qb I PERMIT NO. Lo CJJ LEGAL ( _/ DESCRIPTION LOT BLK ADDITION u SITE AREA 3'" Q Ft. AREA OF SITE OCCUPIED BY BUILDINGS QN� 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.) 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"ID 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. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' r I I/Wei certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. 3 Z) NAME(S) OF OWNER(S) OF SITE a STRUCTURE(3) (PRINT) IGN ITURE OF OWNER(3) OR AUTHORIZED REP ESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DATE DISTRICT AS NOTED CHRISTMASTOWN PRINTING