Loading...
HomeMy WebLinkAboutBLD24758 SFR - BLD Application - 11/13/1989 ., ILDING PERMIT APPLICATION z.. MASON COUNTY �sscj DEPARTMENT of GENERAL SERVICES `JO'J P.O. BOX 186 SHELTON, WASHINGTON 98584 / 427-9670 DATE ISSUED PERMIT NOIZ-1241 NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER �5D COLUKAS 7S-1 1/E_ivTU M Q4 5 DIRECTIONS TO JOB SITE & i" 2i /C OV A_' )e PARCEL NUMBER 3��2 7 d JOC 22 7 LEGAL 4U7 a2y.7 �/1�G L/�'1/Z/UC/ DESCR. NAME MAILADDRESS CITY SSTATE LICENSE NO. ZIP PHONE CONTRACTOR � w �- H,J(?,ip 3R 4?13 Cf l7 USE OF /`>�rn6KAp�t3 9 3 BUILDING S, CLASS OF NE TALTERATION WORK r REPAIR MOVE REMOVE DESCRIBE WORK BEDROOMS '2—� DECKS CARPORT NOTICE q^ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT-? FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL OWNERS FIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF CERTIFY N LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIRE NTS 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 CONF RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINI APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM HE BUILDING DEPARTMENT. X W ER DATE X BY P.'z'0l// DATE FOR OFFICE U E ON LY DEP TMENT Y SPPROVEDJ0 DEPARTMENT YEAPPROVEDtO BUILDING VALUATION 101. S`'b HEALTH PUBLIC WORKS FEE PLANNING mFIRE BUILDING PERMIT 2 ?j3 I^0 D.O.T. BUILDING PLAN CHECK ZS �— SPECIAL CONDITIONS BUILDING GROUP p PRE-INSPECTION SHORELINE 3�y i7 WOODSTOVE 44 PLUMBING Qo MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY C IiS�CK BY APPROVED FOR ISSUANCE PERMIT VALIDATION BY(/- /3-8 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 MAILADDRESS CITY&STATE ZIP -Z-PHONE CP --'LI►V l U►V% — C� DIRECTIONS TO JOB SITE (i �+ ✓L('�11�/ LTL� CCh�( rv' -C: c�z L✓/W vIJ f ,�z�l N ' CYI LEGAL / DESCR. i O. r a? LKe, L,rYl CONTRACTOR NAME . MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE USE OF BUILDINGrC + \ S PLUMBIRIG FIXTU14ES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE I WATER CLOSETS Z 100 FORCED-AIR/GRAVITY TYPE FURNACE 6.00 ( BASINS ©O FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 ( SHOWERS 2- REPAIR/ALTERATION 6.00 A WATER HEATERS C REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER AIR HANDLING UNITS 7.50 SINKS O HEAT-PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT (O c ) LAUNDRY TRAYS WOOD STOVES 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISHWASHER '2-0 0 DISPOSAL URINALS PERMIT BASIC FEE 3.00 PERMIT BASIC FEE 10.00 TOTAL C 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 CHEL�K BV T2,, 3 UILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION Z�„(> ,_, /� - BY [CASH CK MO PLOT PLAN ADDRESS E731 CO/Vl()G_M 'rzA 1,)4--' SH0LTCx ) PERMIT NO. 0 s r = LEGAL DESCRIPTION LOT Z-q 7 BLK j _)- ;7, ADDITION I �; SITE AREA 1 3`� Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS f j Sq. Ft. INSTRUCTIONS TO APPLICANT 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. C INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Rj C �1 1 I ly 2 26 0 I I/We certify that the proposed construction will conform to the dlmensivns and uses shown above and that no changes will be made without first obtaining approval. CD -LxL /Ills o� NAME(S) OF OWNER(a) OF SITE S STRUCTURE(S) (PRINT) I NA E OF O ) OR AUTHORI, EO REP ESENTATIVE DO NOT WRITE BELOW 7'I�IIS LINE APPROVED DISTRICT AS NOTED DATE