HomeMy WebLinkAboutBLD11690 SFR - BLD Application - 11/5/1981 • BUILDING PERMIT APPLICATION �--
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAM MAI AD S J.CITY&STATE Zlt, 8 PHONE
2
DIRECTIONS t�
TO JOB SITE Lko '
LEGAL ❑ SEE ATTACH ID SHEET)
DESCR. C _42
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: 1NEW ElADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
:iJrVe
DesLbwork: Z ` z I
baA A l
if , 1 e '
Valuation of work: $ 2 PLAN CHEC F I FilRMITiEE i e s Ln
J •Qo
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS_ (TOTAL SQ. FT. GARAGE ❑
NO. OF STORIES BASEMENT ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. FT.10d8 FIREPLACE X 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
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 therewith. PERMANENT SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNI T.
OWNERS AFFIDAVIT LTH DEPT. �oZ
P U BUM UffKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will 1AOAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
�I- it 4 _ _ A LICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner j,L�M�/a� Date BY
Py CHECK VALIDATION CK,. M.O. CASH ERMIT VALIDATION CK. M.O. CASH
i 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.
l l.�dr 4 Z Cir. 17 9�5 28
Owner /-� iu l
2. L M (-
Contractor T
l
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signature of applicant Address Application date
LEGAL DESCRIPTION
Location
Of t /
Building
NO.. PLUMBING FIXTURES FEE ,
WATER CLOSETS
BASINS
BATHTUBS �� t 6 F�
SHOWERS �o
WATER HEATERS
AUTO.WASHERS y c)
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
(Show Street Names & Property Lines)
1
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT �1 SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
Il ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by �/ Permit fee Date pemit Issued Permit number Receipt No.