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HomeMy WebLinkAboutBLD92-0181 Cancelled Addition - BLD Application - 4/16/1992 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED ( 7AQ _ I, PERMIT NO. NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER C.R M\CIc nPcD t3Gy a Ct5t 75- t DIRECTIONS TO JOB SITE pYY1CY c rn PARCEL 1i LEGAL rl n �,n NUMBER " ` 0`07 � 4 5a OTbo DESCR. L - IU PI t— at i"IGt IC W. 3 NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR SELF- USE OF BUILDING CLASS OF NEW ADDITION X RATIO EPAI MOVE REMOVE WORK r DESCRIBE WORK Q X 1d L i vl n f O ;rY\ BEDROOMS DECKS O CARP T PA E PERMIT IRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS © TOTAL SQ.FT. E O N NING. NO.OF STORI S L BASEMENT 0 ATTACHED Is ITBECOM NUL VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT MME CED WITHI 80 Y OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTALSQ.FT- . FIREPLACE 0 DETACHED C7 NDONEDFORAP IOD DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT K SHORELINE C) _ 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 OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. XOWNER C-K. mT ,4-DATE `-1 - 1 e- 9 a X BY DATE FOR OFFICE USE ONLY pp.J DEPARTMENT YESPPROVEDJO DEPARTMENT YES NOBUILDING VALUATION eQ HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT L b D.O.T. BUILDING UVl PLAN CHECK 5 (b SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE ( PLUMBING � (� MECHANICAL C STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS C B APPROVED FOR ISSUANCE PERMIT VALIDATION 'D 4., y 1Zy I BY CASH CK MO TOTAL 4 PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. OWNER AME MAIL ADDRE CITv TATE ZIP PHONE c R. iv1�iw r-, 'o• �x �lG �s aLl DIRECTIONS h TO JOB SITE 0�-4 f\ t ( I {- CIe l LEGAL ��� n3 - Blcck01 Lc��' DESCR. CONTRACTOR NA MAILADDRESS CITYSSTATE LICENSE NO. ZIP PHONE USE OF BUILDING LtV( n ROC,fr\ U4) I+-. cn PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE_OF FIXTURE FEE WATER CLOSETS FORCED-AIR I GRAVITY TYPE FURNACE 6.00 BASINS FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 SHOWERS REP /ALTERATION 6.00 WATER HEATERS REF IG ATION COMP ESSOR SYSTEM 6.00 AUTO.WASHER AIR AND ING UNI 7.50 SINKS E -PUM 6.00 FLOOR DRAINS C GAS P G SYS.2.00 PER OUTLET DRINKING FOUNTAINS VE N SYS. 00 PER UNIT LAUNDRY TRAYS FIR PPRESSIO 5.00 CONNECT TO CITY SEWER WOOD RNACE 5.00 DISH WASHER 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 APP OVAL FROM THE BUILDING DEPARTMENT. WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER �S" 'Q' '' ` DATE __1 b' I - X BY DATE FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION BY 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&STATE ZIP PHONE OWNER M 'y CR. 1u C G Ur, ° 5%' 1 - DIRECTIONS T� TO JOB SITECorrec ô Cr&r 4- ClO \cam V Gv friCn� PARCEL I LEGAL NUMBER DESCR. �� �pn Indicate below: O Property lines and dimensions. O Easements and roads. O Septic, drainfield and reserve area, or sewer. O 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. In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage. O Attach copy of septic system "as built" or septic permit approval. O Indicate topography profile of property and structure on reverse side. 3 q' So T 3. 9 I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be ade without first obtaining approval. SIGNATURE OWNER(S)OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE DISTRICT AS NOTED I . DATE �� ��� TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE 1111111111 ETIIIIIIIII l2�