HomeMy WebLinkAboutBLD5510 SFR - BLD Application - 7/6/1977 f BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 f
DATE ISSUED 7/ � /7-7
PERMIT NO. '73 /0
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
T 2 AU ZfdO
DIRECTIONS
TO JOB SITE
LEGAL (❑SEE ATTACHED SHEET)
DESCR. Zo N Z 14 U 4V- �Z
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING ��
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE [] REMOVE
Describe work:
aN -oom-
5
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
,!W
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANA CHECK BY APPROVED FO ISYJANCE Type of Occupancy Division
BY _ Const. Group 7
Size of Bldg. No. of Max. J
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR 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
/ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date, J&17 WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION tCK, M.O. CASH
MASnN (7,01INTX P1. ANNONr nFPAPT!0P#JT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,street.city,and State Zip code Tel.No.
Owner
2.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mz son,,ounty and State of Washington
Signature of applicant Address A— Application date
LEGAL DESCRIPTION
Location /GG 41 Y�Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS I-O
2 BASINS O'd
BATH TUBS 800
SHOWERS
WATER HEATERS L" •'
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS ��
Connect to City Sewer fy
DISH WASHER
DISPOSAL
URINAL
(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
Approveny Permit fee Date pemit Issued Permit number Receipt No.