HomeMy WebLinkAboutBLD93-0110 Remodel - BLD Permit / Conditions - 2/4/1993 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
• 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 date3-- j 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 dategK q_i,� by date by
_ n rye (asp
MASON COUNTY Permit No.BLD
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owne f�t� �� Phone#
Site Address
City .`�/, /f�; . St
Directions to Job Site ' ; y0 v
Owner Mailing Address 61 ,( i ;
City_- /-)11/ ,)-t( z St Oi; Zip
Lien/Title Holder
Address
City St
Zip
#2 Contractor Name >/, / �n, ( /d�_� Contractor Reg#. TCr0/�T.
Address =i5�5i , ,f/, , /�/, Expiration date
City �,,��, ,4 St�� c -
.�..Zip� � �� Phone_. 51.2 t,, -
#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)
e
#4 Parcel No.
21 -"1 -�(- Ra�/fo
Legal Description Lc, F
#5 Building Square Footage: (existing/proposed)
1 Fl 2 nd Fl / 3 rd Fl / Loft /
Basement eck_ / #bedrooms
tiara e - __L _ #bathrooms _
g arport / (Circle: Attached or Detached?)
Other sq ft /
#6 U of b ilding Describe wor
i
B�
#7 Type of Job: New Add Alt Repair Demolitioi�0 mil"
Woodstove Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make � r 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 on the site plan I
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 TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee Fee
' No. '
Toilets Vent Systems X 6 . 00
Bath Basins Vent Fans X 6 . 00
Bath Tubs No. Boilers/Compressors
Showers HP . 00
ater Htr
Laund asher
Sinks No. Air Handling it
Floor Drains cf .
Laundry Basins
Dishwasher No. Fi Protection Systems-
Disposal
Urinals
Other
Permit Basic Fee 15 . 00 No. Other
TOTAL PLUMBING $
Gas Outlets X 6 . 00
dstove, Pellet 25 . 00
Mechanical Fixtures Othe e�
No. Fuel Types
Furn BTU . 00 Permit Basic Fee 15 . 00
TOTAL MECHANICAL $
Heat Pumps . 00
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 BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER BY a
DATE DATE r'—
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;_ Date:_
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond Hold
Approval
Planning:
Environmental Health:
14=rT
Building Plan Review: g5te ,n5pa* Ferennrrk
Y1�I3
Occupancy Group: g-L3
Fire Marshal :
Other:
11 FEES
Ilspecial Conditions: II IlSite Inspection I II
II II I I
II II IlBuilding Permit I II
II II I I
II II IlViolation Fee I II
II II I I
II IIViolation Investigation Fee I II
II �II I I
II II IlPlan Check I II
II II I I
II II II Plumbing Fee
II ii _ - I II
I II IlMechanical Fee
_ II II I I I
II II Ilwoodstove Fee I II
II II I I
I. II IlBuilding State Fee I 11
IlBuilding Valuation: II
II R monitor
TOTAL FEE I I