HomeMy WebLinkAboutBLD9280 Addition - BLD Application - 5/17/1976 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED ` 7
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY f= ATE ZIP PHONE
DIRECTIONS
TO JOB SITE /
LEGAL �. (❑SEE ATTACHED.S.HE►ET)
DESCR. �/Os/ U
CONTRACTOR
NAME 1 PrAll-ADDRES9 CITY&STATE LICENSE NO. PHONE
7� L
USE OF c
BUILDING J
Class of work: ❑ NEW XADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:dd 1' , 1-1 t S I-& w
Valuation of work: $ PLAN CHECK FEE PERMIT F
SPECIAL CONDITIONS:
tAPPLICATIO ACCE TED BY PLA CHECK BY AP VED FO 1S�UANCE Type of Occupancy Division
B Const. / Group ?
��� � r-
�rs Size of Bldg. No. of Max.
(Total)Sq. Ft. ,��� Stories � Occ. Load
C NTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
_ IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
C SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owne Date. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON 117,01INTY PLANNING DIFPAPT"FNT
P.O. BOX 186 Shelton, Washington 9r,584
PLUMBING PERMIT APPLICATION
IMPORTANT Complete ALL items. Mark boxes wi,,ee applicable.
Name Mailingaddress—Number,stre-c-t,rity, irzd'S'ca,e Zip code Tel.No.
f C
Owner
rac Co't .'o'
The owner of this building and the undersigned agree to conform to all applicable laws of Mason Co,jn'y and Siate of 'was,,.ington
Signature of applicant Address Application date
I LEGAL Df SCRIPTION
Location
Of
Building 1-
NO. PLUMBING FIXTURES FEE
WATER CLOSETS y GO
A
BASINS
BATH TUBS
SHOWERS
7,0
WATER HEATERS 2,
AUTO.WASHERS
SINKS L.
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER 2,
DISPOSAL
URINAL
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT '2 3, 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 pernit issued Permit number rReceipt No.
J--
I(C-411 $ z3 . 711317 9 73