HomeMy WebLinkAboutBLD92-1335 Cancelled SFR - BLD Permit / Conditions - 11/20/1997 CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar j
P.O. Box 186 Shelton, Washington 98584
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BUILDING PERMIT APPLICATION
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PLEASE PRINT
#1 Owner L• Phon 31 ��
Site Address
City 7n : '&)P, St Zi
Directions to Job Si e N
Owner Mailing Address
City St_ V.)d_ Zip '�2�
Lien/Title Holder
Address
City St Zip
#2 Contractor Name Contractor Reg#
Address Expiration date _
Cit St Zip Phone A4�lq-�1�`�P�,
#3 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 L 3p�(,Z„ oglW
#5 Building Square Footage: (existing/proposed)
,�``Est FI 2nd. Fl 3 rd Fl / Loft /
Y asement / Deck #bedrooms #bathrooms
Garage / Carport (Circle- .Attached r Detached?)
Other sq ft / .�+rl9zo
1 �0�
#6 Use of building uoo Describe work)
#7 Type of Job: Ne Add Alt Repair Demolition
Woodstove Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length_ Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
Lot Dimensions Flood Zones
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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 TOPOGRApgy PROFILE BELO
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#7�'ltk '
Fee
No. Toilets °� Vent Systems X 3 . 00
Bath Basins .Vent Fans X 3 . 00
Bath Tubs . No. Boilers/Compressors
Showers � �=- 0-3 HP �
0
Hot Water Htr Z 3-15 HP 6 . 00
Laundry Washer z..Sinks 15-30 HP
� ;�
Floor Drains �... 30-50 HP
50 + HP
Laundry Basins No. Air Handling Unit
Dishwasher
<- 10000 cfm.
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 2 . 00
No. Fuel Types Woodstove separate
Furn < 100K BTU 6 . 00 Other
"''®I_Furn >= 100K BTU _6. 00
Furn - Floor 6 . 00 Permit Basic Fee 1 0
Heat Pumps 6 . 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 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 WASHINGTON 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 OBTAINING APPROVAL FROM THE DEPARTMENT. DEPARTMENT. BUILDING
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
FOR OFFICIAL USE ONLY: Accepted by-16 Date: _ S ��2
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.�.-� -..�� roe"� V✓r. V�{�Ji
Approved Cond Fold
Approval
Planning:
bMS1
Environmental Health:
l�
Building Plan Review: -t�i1 MM;l- MZEJ 4t2 cKcj,- n All
Occupancy Group:
Fire Marshall:
Other:
FEES It
IlSpecial Conditions: II Ilsite Inspection I II
11 II 1i �1
11 11 Il Building Permit
11 11 H '1
11 11 (lviolation Fee I 11
11 II C ;I
11 11 (lviolation Investigation Fee I II
Il II H
II 11 IlPlan Check
11 Ii 'I
1I 11 IlPlumbing Fee
1 II
11
I
11 limechanical Fee
11 H 'I
11 IlWoodstove Fee I II
11
11 11 IlBuilding State Fee
11Building Valuation: 5e7 II 11 TOTAL 1