HomeMy WebLinkAboutBLD92-1183 SFR - BLD Permit / Conditions - 9/21/1992 Nc C .aT.��2-
MASON ccul _'
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner __ f ►^O r C ►`1`_Phone# 73 J I `I
Site Address ' J l
—St lz Zip
G Directions to Job Site c' S'� �r (strs-) N Ly-
To A )— 1� ,
Owner Mailing Address Uk
City St Lzr', Zip
Lien/Title Holder
Address
City St Zip_
#2 Contractor Name Vlg�� "V# Contractor Reg#_^JaC-Acr,C{L
Address f 0, ( E) Expiration date
City �, 1'1 �►�' St Zip 'T Phone
#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. c-) S _
Legal Description -i r
#5 Building Square Footage: (existinq/proposed)
1st Fl �Y-c� / Znd Fl / 3rd FI / Lott /
Basement / Deck /` #bedrooms
_� /_ #bathrooms
Garage / Carport - / (Circle: Attached or Detached?)
Other sq ft /
#6 Use of building Describe work
#7 Type of Job: New_ Add_ Alt_ Repair Demolition
Woodstove Re-Roof_ Bulkhead Other
#S ffi3BILE HOME INFORMA'r''rON
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
Show following an the site plan
i
Lot Dimensions Flood Zones
..xisting Structures Fences
St=scture Setbacks Driveways
water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed ZmProvements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELOW
to
3s Zc7 —
ex-
APPLICANT TO DRAW TOPOGRAPffy PROFILE BELOIg
i
each)
No i Toil=_ts 2 'lent Svs =_ms 3 . 00
Bath Basins Z `a Vent Fans X 3 . 00
_
iBath Tubs No. Boilers/C�rrressors
Showers 0-3 HP 6 . 00
Hct Water itr -Z 3-15 HP 6 . 00
f; Laundry Washer 15-30 HP 5 . 00
Sinks 3 0-5 0 HP . 00
_
Floor Drains 50 + HP 9 . 00
Laundry Basins No. Air Handling Unit
iDishwasher <� 10000 c4m. 7 . 30
Disposal > 10000 cfm. 7 • 50
Urinals Other
Other Evan Coolers
Hoods s `
Permit Basic Fee 3 . 00 Fire Suppression
TOTAL PLBMBING $ Domes . Incin.
C0=1 . Incin.
Reloc/Repair 6 . 00
Mechanical Fixtures Gas Outlets X 2 . 00
No. Fuel Types Woodstove sevarate
Furn < 100K BTU 6 • QQ Other
Fury >a 100K BTU 6 . 00
Furs - Floor 5 . 00 Permit Basic Fee 10 . 00
Heat Pumps 6 . 00 TOTAL MECEANICAL
cack_ �._�� � Nea �e�r
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION.
AUTHORIZED IS NOT COMMENCZ0 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 AFF=AVIT CONTRAC.ZI7RS AF'FmAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REDUIREMENTS 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 AMC THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SMALL BE WIDE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHQUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY dei -
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 OFPIC2AL USE ONLY: Accepted by }� Date��✓ a
D EP ARTI�IENT U RE VIE w
FOR OFFIC3 USE 037LY
Aooroved Coed Hoid
Aoproval
i
Planning: hn
I►l�
Envira=ental Health:
Building Plan Review:
Occupancy Group :
Fire Marshall :
Other:
FEES
IISpecial Conditions: II iiSite Inspection I II
II II II Building Permit
II
it I I
II U II JIViolation Fee I II
IIGENERAL SE II I
RVIC S it IIViolation Investigation Fee 11
I II
II II I, 'I
II II II Plan Check
II T3- II II Plumbing Fee I II
II Ii 17
'
II II IlMechanical Fee �I
II
II II II Woods t ove Fee I II
Buildin
II II g State Fee s
IlBuilding Valuation: TOTAL s II
it
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