HomeMy WebLinkAboutBLD18502 SFR - BLD Application - 4/11/1986 • 4
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 q- 1 I p
DATE ISSUED O l�
PERMIT NO.
OWNER NA E MAI DR S / T CITY STATEjlPd 2 PHON
—
DIRECTIONS
TO JOB SITE � T lF ei� �'o l►!6!f /� -flf�"Sm —LAG N f/VGff to
LEGAL /
DESCR. (❑ SEE ATTACHED SHEET)
NAME 6. MAIL ADlllD---RREJESS CITY&STATE LICENSE NO. PHONE
CONTRACTORJ,J�
�C 77, Q �= S37 3w
USE OF
BUILDING Cp /.T,9G�
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
hQ
Vz
sITL IN2EC-Pow
O
Valuation of work: $� AN CHECK E PERMIT FEE �>
SPECIAL CONDITIONS:
BEDROOMS DECKS _1011C2c7 CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT.� GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIE+SS,,,// BASEMENT El �� OR AIR CONDITIONING.
TOTAL SQ. FT.[L2— FIREPLACE El 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 FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I am aware of the rFOR OFFICE U S N LY
dInance requirements regulating the work for which
he permit is issued and all work done will be in
co rmance therewith. PERMANENT ❑ SHORELINES
SEASONAL FLOODPLAIN ❑
FirmLen— t
E.D. NO. S.E.P.A. ElBy Special Approvals IN OUT APPROVED
YES NO
Li o. &QWL 322T/T _Date �— ZONING
PLANNING DEPT. —
OWNERS AFFIDAVIT HEALTH DEPT. `� _
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 Q APPROVED FOR ISSUANCE
Owner Date BY
PLAN CHECK VALIDATION K. M.O. CASH U J PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY
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.
1.
Owner
2.
Contractor
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
Building
NO.. PLUMBING FIXTURES FEE
1 WATER CLOSETS
BASINS
P BATH TUBS
i
SHOWERS
WATER HEATERS ,
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
Qom'/�' ���- .�•�
(Show Street Names 8 Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
HP
ERMIT 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.
$
CHRISTMASTOWN PRINTING /