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Home My WebLink AboutWorkshop - BLD Application - 5/25/1988 BUILDING PERMI 7 APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED _ PERMIT NO. OWNER NA MAIL ADDRESS CITY&STATE ZIP PHONE John ' DIRECTONS TO JOB SITE � . u • i'C:S� ut .3aaoy - 4 3 - 0o2.5 PARCEL LEGALTPT NUMBER DESCR. �11 G 3c, Ac, _s csP 5 NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE CONTRACTOR USE OF t • ' j_ BUILDING CLASSOF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE WORK r l WORKDESCR FjLl1 ' L-,-orksh c,P BEDROOMS DECKS CARPORT NOTICE SEPARATE PERMITS AR RED FOR,PLUMBIN�HEATING, TING OR AIR BATHROOMS TOTAL SQ.FT. GARAGE CONDITI NO.OF STORI ES BASEMENT ATTACHED 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 TOTAL SQ.FT. y5t� FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIMEAFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL 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 OBT NING APPROVAL FROM THE BUILDING DEPARTMENT. p APPROVAL FROM THE BUILDING DEPARTMENT. NER.�Q/(E�?J�(![—! �iARTE /Z X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION r YES NO YES NO C .S'L, HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT 3 G� D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING tee MECHANICAL , STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CH /K BY APPROVED FOR ISSUANCE PERMIT VALIDATION L cC',�'�L_ 1� BY /��- CASH CK MO TOTAL �� PLUMBING & MECHANICAL. PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. OWNER �✓ NAME MAIL ADDRESS CITY BSTATE ZIP PHONE DIRECTIONS TO JOB SITE LEGAL DESCR. CONTRACTOR NAME MAIL ADDRESS CITY BSTATE LICENSE NO. ZIP PHONE USE OF BUILDING PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS ,w FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 SHOWERS REPAIR/ALTERATION 6.00 WATER HEATERS 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 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 TOTAL 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 THEREWITH. NO CHANGES SHALL BE MADE WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE X BY DATE FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION BY CASH CK MO PLOT PLAN' ADDRESS G 3 ' �O U ., D i'1 1�1(s P1r� 1�.�• �/'6N.-I PERMIT NO. y o = s � LEGAL w Z I� � ^ DESCRIPTION LOT BILK ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. INSTRUCTIONS TO APPLICANT W THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' I ) '77 N� I I' S � 1J , I/We certify that the proposed construction will conform to the dimansi&ns and uses shown above and that no changes will be made without first obtaining approval. NAMri(al OR OWN[R(S) OF SITE ! STRUCTURE(S) (PRINT) SIGNNTUR OF OWNER(S) OR AUTHORIZED D REP SESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DATE DISTRICT AS NOTED F57th & rch Thurston-Mason Health District Court House Annex Shelton, Washington DIVISION OF SANITATION Olympia, Washington Phone: 426-4407 � / �� Phone: 3524851 Owner 1, Y r l I Phone Z / Mailing Address F o-9 City S11 �O f"61J State Builder ":' y / ,� Address Sewage Contractor� Address '��'"t�1E' Legal Description -.'7 p„ r ` n Parcel No. Field Book No. Directions to Property 1- IZA Intended uses of Building �1 Z7 Public Sewer Water Supply y ,_ No. of Bedrooms J? No. of Bathrooms_ Basement Septic Tank �� Type of Soil C ��1 hot Size S Soil Drainage: Gbod Moderate Poor None DRAW SKETCH in blank space or on separate sheet indicating the following: 1. Property lines and location of house on lot and indicate minimum and maximum setbacks plus dimensions of lot and all buildings. 2. Location of house and sewage disposal system in relation to streams, lakes, wells, patios, driveways, underground tanks, water supply lines and easements. 3. Proposed fill, including depth, area, porosity and amount plus location of drains. 3 � 4Q Q') �r< APPLICANT'S SIGNATURE 11 _1E & DATE Site inspection fee $10. 00 Receipt No. By Approved *Z�'vtct Not Approved B ate Date S&initarian ,rr)fT-M_S-1-3 9