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HomeMy WebLinkAboutBLD5694 SFR - BLD Application - 8/4/1977 •M 7 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 DATE ISSUED b �/7 7 L ( ' 13 PERMIT NO. �fc OWNER f NAM / MAIL ADDRESS ` CI &STATE ZIP ZIP PHONE j G � (/c v T DIRECTIONS TO JOB SITE LEGAL y� r DESCR. q t (❑SEE ATTACHED SHEET) /V CONTRACTOR NA MAI A DRES TY&STATE p, LICENSE NO. PHONE USE OF BUILDING /9�1� Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Descrriiby work:6V �/ "-&) �etr✓lZ� Valuation of work: $ © v PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: APPLICATION ACCEPTED BY PLANS CHECK BY APPFJOAED FOR I ANCE Type of Occupancy Division _ Const. Group L Size of Bldg. No. of Max. CONTRACTOR AFFIDAVIT (Total)Sq. Ft. Stories Occ. Load 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 of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, which this permit is issued and that all work done will VENTILATING OR AIR CONDITIONING. b Co for ce therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS Own r Date_ WORKSUSPE NS COMMENCEDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER AN CHECK VALIDATIO CK. M.O. CASH PERMIT 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. 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 Appl' tiond/a�te L GAL DESC TIQN v f 4- Location Of ={ Building NO.. PLUMBING FIXTURES FEE WATER CLOSETS BASINS Q !dA Sle Ia�y ' BATH TUBS � SHOWERS WATER HEATERS �O 0 li I AUTO.WASHERS t SINKS FLOOR DRAINS fC ' DRINKING FOUNTAINS P) LAUNDRY TRAYS �Q Connect to City Sewer DISH WASHER DISPOSAL URINAL --_ on (Show Street Names & Property Lines) ZAI 4o 0 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. A"1410l% 7r - ova 0