HomeMy WebLinkAboutBLD92-00921 Cancelled ReRoof - BLD Application - 10/10/1992 MASON COUNTY Permit No.3LD9-)-69'
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner / Phone#
Site Addr s
City St ZipZILE
Dire ctio s to Job S ' e
r,�►i's�
Owner Mailing Ad ess r g
City St 1,
Zip -�
Lien/Title Solder
Address
City St Zip
#2 Contractor Name Contractor Reg#
Addres Expiration date-
City St_zip --Phone
#3 If septic is located on project site, include records.
Connect to Septic?v,�_ public Water Supply�y Well
(If residential, p oof of potable water may be required)
#4 Parcel No.
Legal Description L) /6 SIc
#5 Building Sc
,g=e Footage: (existing/proposed)
ist Fl /SJ° / 2nd Fl / 3rd Fl / Loft -- /
Basement / — Deck / #bedrooms / , #bathrooms�L
Garage / Carport - i / (Circle: Attached o Detached?
Other sq ft /
#6 Use of buil ng Describe rk
#7 Type of Job: New Add Alt Repair Demolition
Woodstove_ Re-Roof_ Bulkhead Other
#8 I MBILE HaME 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
Show following on the site plan
Lot Dimensidfis 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 ro" ating Street Date:
APPLICANT TO DRAW SITE PLAN BELO
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
F;xtuzes (S2 each) Fee Fee
NO TOillets Vent Svst_ms X 3 . 00
Bath Basins Vent Fans X 3 . 00
Bath 'bibs No. Boilers/C=pressors
Showers 0-3 HP 6 . 00
Hot Water Htr 3 - i5 HP 6 . 00
Laundry Washer 15- 3 0 HP 5 .30
Sinks 30- 50 HP
5 . 00
Floor Drains 50 + HP 5 . 00
Laundr, Basins
1 No. Air Handling Unit
Dishwasher <- 10000 c!m. 7 . 50
Disposal > 10000 crm. 50
Urinals Other
Other Ivan Coolers
Hoods --�
Permit Basic Fee 3 . 00 Fire Suppression
TOTAL PLUbOING $ Domes . Inc4n.
Comma . Incin.
Reloc/Repair 6 . 00
Mec�Ianicai Fixtures Gas Outlets X 2.00
No. Fuel Types Woodstove seAarate
Furn < 100K BTU 6 . 00 Other
Furs >- 100K BTU 6 . 00
Furs - Floor 6 . 00 Permit Basic Fee 10 . 00
Heat Pumps 6 . 00 TOTAL 30CMA►NICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AM70PIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTF.,R WORK
IS COMl1'fENC=
OWNERS A F=Avrr COPITRAL-MRS AFT=AV=
I CERTIFY THAT I AN CWVT FROM THE REWIREMENTS OF THE I CERTIFY THAT I AN A CLURRENTLT REGISTERS CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 13.27 , AND AN SHARE IN THE STATE OF WASMINGTON MD I AM AVARE Of THE OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WNICH ORDINANCE REOUIREMN:HTS REGULATING THE WON1< FOR YN[CH
TNIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL NNE IN THE PERMIT IS ISSUED AND ALL WORK OOE VILL tE IN
CONFORMANCE TMERELIn. NO CHANGES SMALL SE MADE CONFORMANCE THEREWITH. NO CNNANGES SHALL N MADE
WITHOUT FIRST OBTAINING THE iwILDING VITNOUT FIRST OBTAINING AP"MAL FROM THE !)LlIlDING
DEPARTMENT. DEPARTMENT.
Z OWNER 7,// � Z HY
DATE 0=
Return permit to: Department of General Services
426 w. Cedar/P.O. Box 186, Shelton, PIA 98584 427-9670/1-300-562-5628
FOR OFPICIAL USE ONLY: Accepte � Dater ,
DEPA RTN EIN'I .0 REVEL'
FOR OFFIC3 USE MM*T
Pt7ravd [ond Maid
Appravl
viroameatal Health:
Building P1aa Rev-jaw: ' 1
OCC IP&MCy Group
Fire Marshall :
Other:
w FEES
aSpecial Conditions: q gSite Inspection l q
a �
a
II gBui_ding Pe=it
II Il I �
q gviciation Fee l q
II q
II q gviolacioa Investigation Feel q
a q
a q gPlan Check l q
II q
II II UPlumbing Fee I q
II II n �
II Il IlMechanical Fee l q
II I. i n
II '11
II II IlWoodscove Fee l Il
I
If Il L �l
If Il IlBuilding Stace Fee I IfIIBui;di.^.g Va?Valuation: 1I II II II ' --i)
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