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Home My WebLink AboutBLD28672 SFR - BLD Application - 7/23/2009 BUILDING PERMIT APPLICATION h MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED 05/ PERMIT NO. aA ME �� MAILADDRESS CITY&STATE ZIP PHONE OWNER /�', l t�'� 5-6 U a 1',F h'. d, S c w-✓ Gv >"9 t V 2.--J-3 o, DIRECTIONS TO JOB SITE , A- 'd'v A jkr PARCEL LEGAL NUMBER �.i I� DESCR. S' -r-2- N IZ 3 v C,-z/ F.-SA /=ke NAME MAIL ADDRESS CITY 8 STATE L.IC/ENSE NO. ZIP PHONE CONTRACTOR r 1 /a caw _ r/7R�C Pa gQs-gt -3a7 USE OF BUILDING rp CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK lean idt BEDROOMS —3 DECKS YORN CARPORT NOTICE TOTAL SQ.FT. DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS— TOTAL SO.FT. 1�- TOTAL SQ.FT. AWA CONDITIONING. NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT. . 7 TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT_ FIREPLACE _�&JA ATTACHED SEASONAL SHORELINE N DETACHED 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 REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDI G DEPARTMENT. APPROVAL FROM THE BUILDING DEPA MENT. X OWNER DATE 6 - / - 9 / X BY DATE/_7 9 FOR OFFICE USE ONLY DEPARTMENT YEAPPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING Q� MECHANICAL L� STATE BUILDING FEE J , STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK By APP VED F ISSUA P RMIT VALIDATION TOTAL � - BY � � I CK MO � PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED v PERMIT NO. C�&Q OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE f/ '7 c cz7"l:` A /y l . s'Y '126-s 30 7 DIRECTIONS TO JOB SITE y Ad ra .2 j,r,r k 12,4 na LEGAL _ DESCR. ' .3 ti/ 1 1 ) A/ 3 W Lim /7 Cam-l r%S kg CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE F 'a t,/ cc-.* � a s'1 F'% i k OW 5 /^, s, f/1ii%C 177 vs-1 3c_7 USE OF BUILDING PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FE NO. TYPE OF FIXTURE FEE WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 2 SHOWERS REPAIR/ALTERATION 6.00 1 WATER HEATERS Z REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER AIR HANDLING UNITS 7.50 SINKS HEAT•PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT 3 LAUNDRY TRAYS WOOD STOVES 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISHWASHER DISPOSAL URINALS PERMIT BASIC FEE 3.00 PERMIT BASIC FEE 10.00 TOTAL TOTALzp 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 T EREWITH. NO CHANGES SHALL BE MADE WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING PP THEBUILDINGDEPARTMENT. WITHOUT FIRST OBTAI IN FROM THE BUILDING DEPARTMENT. X OWNER DATE - .1 — X BY 1 7�D` ��f DATE — /7--q Z FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION IBY CASH CK MO BUILDING PERMIT PLOT PLAN MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE OWNER E T�1 o yl r Y 'L 2-i s 7 DIRECTIONS TO J08 SITES<d PARCEL kD 1- 7 LEGA-T L. NUMBER Czjt� /Ii DESCR. j 3 L� �2/ �t� �J li✓ Indicate below: O Property lines and dimensions. O Easements and roads. O Septic, drainfield and reserve area, or sewer. O Septic tank and drainfield setback distances from foundations. O Location of proposed construction on property. O Building & septic system setback distances from all property lines& easements. Indicate North O Well and water line. O Saltwater, lakes, rivers, streams, wetlands, drainage. In Circle O Attach copy of septic system"as built' or septic permit approval. O Indicate topogra -profHeof property an_ structure on reverse side. IA n V °,► L' o ► + Lv s a Pu •S 3 9C I IT � v, v _ a I/We Certify that the proposed construction will conform to the dimensi Ins and uses shown above and that no changes will be made without first obtaining approval. I SIGNATURE OF OWN (S)OR AUTHORIZED RZPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPRoVpn I TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE I i I