HomeMy WebLinkAboutBLD13064 SFR - BLD Application - 9/24/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED —�2
PERMIT NO. (� ��L"/
OWNER NAM MAIL ADDRESS CITY 8 STA E ZIP PHONE
DIRECTIONS
TO JOB SITE L
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRE�s CITY&STATE LICENSE NO. PHONE
CONTRACTOR - /3tf2C> �, �Sfl� r
USE OF ����
BUILDING 0
Class of work: XNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
T71, ErJCW _ M-7)1
Valuation of work: $ .y� r-O PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITION ,.
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SO. FT. GARAGE ❑
��jj ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES�t BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT/,, 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 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 i
SEASONAL FLOODPLAIN C_]
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. 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
of the Mason County ordinance requirements for BUILDING DEPT. y'y �?° $,�
which this permit is issued and that all work done will ROAD ACCESS
be in conforrmanctthe ewith. MOTOR VEHICLE PERMIT
P r 1�t A ICATION ACCEPTED Y PLANS CHECK BY APP VED FOR ISSUANCE
Owne
I Date. BY"
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. 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.
t. a
Owner �C�'A
A -I b(J
z.
Contractor
The owner o is building and the undersigned agree conform to all applicable laws of Mason County and State of Washington
Sign re of applicant Address
� � Application date
o
LEGAL ESCRIPTIO
Location
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS /1
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
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
Approved by Permit fee Date pemit issued Permit number Receipt No.
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