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HomeMy WebLinkAboutBLD10499 - BLD Application - 5/1/1981 BUILDING PERMIT APPLICATION • MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED PERMIT NO. �y ` OWNER N MAIL ADDRESS CITY&STATE ZIP PHONE �' 4'-1 to• o DIRECTIO46 TO JOB SITE , , (❑SEE ATTACHED SHEET) LEGAL DESCR. _ NAME w MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING Class of work: ❑ PEW ADDITIOW ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: ©e c Valuation of work: $ PLAN CHECK,f� -,`� PERMI E sr-/V 7 SPECIAL CONDITIONS: 1Q' BEDROOMS DECKS CARPORT)c Iy hop NOTICE BATHROOMS TOTAL SO. FT. -GARAGE ❑ ATTACHE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. TOTAL SQ. FT. Qd 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 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 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 ❑ FLOODPLA14 ❑ Firm E.D. NO. S.E.P.A. ❑ Special Approvals IN OUT YES APPROVED NO By Lic. No. Date ZONING PLANNING DEPT. / 5^ 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 94 be in conformance therewtt . MOTOR VEHICLE PERMIT �r/ {�'/ AP ATION9& ACCEPTED BY PLAN CHECK BY/ APPROVED FOR ISSUANCE Own r Date. a �s�-G' BY - c'/" P AN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION V 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 e Jb , ) 2. SQ/ �(jw 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 / G�• Building NO.. PLUMBING FIXTURES FEE WATER CLOSETS O BASINS BATH TUBS I SHOWERS QI. O a WATER HEATERS AUTO.WASHERS SINKS FLOOR DRAINS DRINKING FOUNTAINS LAUNDRY TRAYS Connect to City Sewer f DISH WASHER DISPOSAL URINAL —. (Show Street Names 8 Property Lines) INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER. PERMIT t t7 SKETCH IN SEPTIC TANK 8 DRAIN FIELD LOCATION OR SUBMIT ON OTHER SKETCH. DO NOT WRITE IN THIS SPACE — FOR OFFICE USE Approved by s', Permit fee Date pemit Issued Permit number Receipt No. `g $