HomeMy WebLinkAboutMIS92-00092 Cancelled Sign - MIS Permit / Conditions - 10/23/1997 i
MASON COUNTY PERMIT
NULL 8 VOID BY EXPIRATION
Mason County Bldg. III 426 W. Cedar DATE BY
P.O. Box 186 Shelton, Washington 98584
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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
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MASON COUNTY
Mason County Bldg, 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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Permit No.BLD
MASON COU=
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner K 1 � Phone# a9s zo ZO
Site Addres 10 VIA
City St Zip
Directions to Job Site
�Ix (�)
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Owner Mailing Address
City St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name -1��,,�5�� �C,,� �' Contractor Reg#A"sOz*ZZ.I'
Address C) L l,�j C—ZD�5;�- StA-Dod Expiration date X-Lcity �' M S t(A�Lip G 831 Z Phone 3`1 (o O(`')
#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
Legal Description
#5 Building Square Footage: (existing/proposed)
Ist F1 / 2nd FI / 3rd Fl / Loft /
Basement 1 Deck / #bedrooms I _ #bath=cros I
Garage / Carport / (C rcle: Attached or Detached?)
Other =-5icl 1,'-\ sq ft
#6 Use of building ' Describe work STi4<
P— Sze jZz 2Ac 1?
#7 Type of Job: New, Add Alt Repair Demolition
Woodstove Re-Roof Bulkhead Other !F -D
#8 LABILE 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
Pi umbina Fixtures ($2 each) Fee Foe
No . Toilets Vent Systems X 3 . 00
Bath Basins Vent Fans X 3 . 00
Bath 'bibs No. Boilers/Compressors
Showers 0-3 HP 6_00
Hot Water Htr 3 - 15 HP 6 . 00
Laundry Washer 15-30 HP 6 . 00
Sinks 30-50 HP 5`00
Floor Drains 50 + HP 6_00
Laundry Basins No. Air Handling Unit
Dishwasher « 10000 cfm. 7 . 50
Disposal > 10000 cfm. 7 . 50
Urinals Other
Other 'vac Coolers
Hoods
Pe=it 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 segarate
Furs < 100K BTU 600 Other
Furn >a 100K BTU 600
Furn - Floor 6 . 00 Permit Basic Fee 10 . 00
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 AN EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AN A CL1RRENTLT REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAY RCM 13.27 , AND AN AWARE IN THE STATE OF WASHINGTON AND I AN 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 SMALL BE M OE CONFORMANCE THEREWITH. NO CHANGES SMALL BE MADE
WIT1N117T FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
OEPARTNENT. DEPARTMENT'
X OWNER X BYju
DATE DATE FA
�(2-
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, PIA 98584 427-9670/1-800-562-5628
FOR OFFICZAM USE ONLY: Accented bv: Date:
,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 Scale:
Name of Fronting Street Date:
APPLICANT TOODRAW SITE PLAN BELO
SEC. 'I 0---�>
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
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DEPARTMENTAL. REVIEW
FU$ oFFIas US$ ONLY
Approved Cond Hold
Approval
Planning: A , �f sc�c, 6VOAA
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Environmental Health:
Building Plan Review: 'nn�
�V1
Occupancy Group : aw Iu
Fire Marshall :
Other:
FEES
(ISpecial Conditions : II IlSite Inspection I ((
II it IlBuilding Permit
it II I I
it II Ilviolation Fee ( I(
11 II Ilviolation investigation Fee - I II
II it 1'
II it Il Plan Check
II II I` - ;I
II it II Plumbing Fee I II
II II 1 it
II II 11mechanical Fee I II
II 11 1' it
II 11 IlWaodscove Fee 1 II
II 11 I' - it
it 11 IlBuilding State Fee ( II
IL 'I
IlBuildinc valuation: 11 �I TOTALI� U�" II
if '1 1 1