HomeMy WebLinkAboutBLD10603 SFR - BLD Application - 5/18/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
PERMIT NO. a6
A �MAILA I 8 STATE ZIPPHONE
OWNER CC. " 3�
DIRECTIONS ,
TO JOB SITE
SHEET)
LEGAL (❑ SEE ATTAC D
DESCR. bt! le2! 7 W IP-2- ;l C I 141 df
NAME MAIL DDRESS Qn. CITY 8 9TATE LICENSE NO. PHONE
CONTRACTOR 7M1
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
AXIQ
Describe work: _ 67 �.
Valuation of work: $ PLAN HECEE PE IT FEE.,
SPECIAL CONDITIONS: a!!,
e
GrU
. U
BEDROOMS DECKS CARPORT ElNOTICE
BATHROOMS TOTAL So. FTL�— GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT./0 FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED 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.
I certify that I am a currently registered contractor in
the State of Washington and I am 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
PERMANENT
conformance therewith.
SHORELINES ❑�,(,
ao
SEASONAL ❑ FLOODPLAIN i1
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT
YES APPROVED NO
Lic. No.
Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT 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
AP LIGATION ACCEPTED BY PLA HECK BY APPROVED FOR ISSUANCE
Owner42!4� Date . "' 4 BY,-,)
�
/AN 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 Q
z.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signature li� 12, Application date
,h.�
LEGAL DESCRIPTION0A I ) i I�
a
Location
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS ( . (��o •
BATH TUBS
L SHOWERS kf;/
WATER HEATERS 14 -_0,
/ AUTO.WASHERS ✓ � u
l SINKS ^�+
! FLOOR DRAINS
O DRINKING FOUNTAINS
LAUNDRY TRAYS ' :" I )n �, av yea,(44
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL u! tLd
O
r �
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by ^ Permit fee Date pemit issued Permit number Receipt No.