HomeMy WebLinkAboutBLD9354 SFR - BLD Application - 10/4/1979 • = '" BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �d �7
PERMIT NO.
OWNER AME j MAIL ADDRESS #CITY&STATE ZIP PHONE
Q �`el�Yd U *"
DIRECTIONS e v24Q'e1 v
TO JOB SITE I U N%e L.4.3 'eaJ 1J"'
LEGAL (❑ SEE ATTACH D SHEET)
DESCR. zo
eP i
AME MAIL ADDRESSCITY&STATE LICENSE NO. PHONE
CONTRACTOR 5Q C 6/S �� Y S
USE OF �-31?�A—/z,
BUILDING
Class of work: W ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe wo
oalo
Valuation of work: $���/ C)� d� PLAN CHECK FEE PERMIT FEE/�/19
.10
SPECIAL CONDITIONS: Y 7 T
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS_ �_ TOTAL SO. FT.,OdM GARAGE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES I BASEMENT A_ ATTACHED ❑ OR AIR CONDITIONING.
JL
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
loq NTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewlt PERMANENT SHORELINES ❑
A t+c 9( r SEASONAL ❑ FLOODPLAIN ❑
Firm Q`v L�ti`J�w` wK'er ; E.D. NO.
S.E.P.A. ❑
By ,Q `� /�� Special Approvals IN OUT YES APPROVED NO
Lic. N //Q� ��"� ►p ��/ /-�\ Date !0 ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. Q Q
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY PROVED FOR ISSUANCE
Owner Date. e
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
Name Mailing address—Number,street,city,and State Zip code Tel.No.
Owner
2. r?S<�'� v E� ,�i'K tfc� ` c• S F' �'-� f�'j�Q "^ S
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signature o pplicant Iddress Application date
0-1
Of/ca ti c,n
LEGAL DESCRIPTION
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS d7y
r-^ SHOWERS ,
WATER HEATERS
AUTO.WASHERS
SINKS �Z b
._-. FLOOR DRAINS I�
DRINKING FOUNTAINS
4 -�
ILAUNDRY TRAYS
Connect to City Sewer i
f DISH WASHER C Zl "�� ��., p_ N
DISPOSAL I C ' a
URINAL ` y
(Show Street Names 8 Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT •�7 j SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved b1 Permit fee Date pemit issued Permit number Receipt No.
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