HomeMy WebLinkAboutBLD0061 Adding 2nd Floor and Additional Room - BLD Application - 7/26/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 121'
PERMIT NO. 65 b
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL —�;' Q,� --{-� _ (❑SEE ATTACHED SHEET)
DESCR. L,6 J f �-3 P�!! ! CF , Pr> T5:
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR Vl^ C L
USE OF
BUILDING U V ` tj `
Class of work: ❑ NEW XADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: t
IC) 1 cr'1 s v L
Valuation of work:0 $0 p PLAN CH CK FEE PERMIT FEE
0 �` s %F
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOT
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
C NTRACTOR 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 rl_am�urently 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 ❑ FLOODPLAIN ❑
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 MARS
contract or registration law RCW 18.27, and am aware �.
of the Mason County ordinance requirements for UILDING DEPT.__)
which his permit is issued and that all work done will ROAD ACCESS
be i conformance therewith. MOTOR VEHICLE PERMIT
/Srs APPLICATION ACCEPTED BY PL S fCK BY APPROVED tAISSUANCE
Owner f Date. r l �� eY ado
PLA CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
r 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.
( G � �
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
Signature of applicant Address Application date
LEGAL DESC IPTION
Location
Of
Building
NO.. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS n
/
BATH TUBS
SHOWERS `
WATER HEATERS
AUTO.WASHERS O�
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS 9 T
LAUNDRY TRAYS �4(�Anat C
Connect to City Sewer I ��
DISH WASHER
1 �ip0
DISPOSAL
URINAL I I
O I
a—Azi6eiz —P—L
--- Iwo t 5
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK 6 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.
$