HomeMy WebLinkAboutBLD11074 SFR - BLD Application - 7/23/1981awl
' BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
EIRECTIONS
R NAME M� ESS
CITY 3 STATE IP PH NE
'
SITE y� C 1ST (jQt�-,r 1c,
LEGAL C�
DESCR. I r�T j (❑ SEE ATTACHED SHEET)
NAME �t MAIL ADDRESS ( ,
CONTRACTOR CITY 6 sTATE L ENSE NO. PHONE
nClass..of
C�r
Sj C j-G F*? IL A_ `� j N G
ork: kd NEW ❑ AD�DITIION 0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Descre work: /�
o�
�71
Valuation of work: $ PLAN CHECK FE
--�_ PERMIT FF .)
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑
BATHROOMS TOTAL SO. FT. ,GARAGE �oo�' NOTICE
NO. OF STORIES BASEMENT El ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SO. FT. FIREPLACE DETACHED OR AIR CONDITIONING.
CONTRACTOR AFFI AVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
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 am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT. � SHORELINES
���� /A ��A,� 1 SEASONAL FLOODPLA1 ❑
Firm � /�JK- /f�^SL3L
E.D. NO. S.E.P.A. ❑
By `.' Special Approvals IN OUT YES APPROVED NO
Lic. No.�"" 1 " "v�F� ��t�Date
PLANNING DEPT. _
OWNERS AFFIDAVIT
PU LIC WOR
I certify that I am exempt from the requirements of the
centract or registration law RCW 18.27, and am aware FIR ARSHAL
f the Mason County ordinance requirements for BUILDING DEPT. �2 t Z�
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith.
O VEHICLE PERMIT
Date_ APP TI EPTE BY PLANS CHECK BY APPROVED FOR ISSUANCE
VALIDATION CK.. M.O. CASH PERMIT VALIDATI 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.
O r
Owner `7►
c �-
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 Appli lion date
LE AL DE CRIPTION
Location / ??
B Lo-r�
Building J,3
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
Qa t�i , Lb
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER n
DISPOSAL O�
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 ecelpt No.
OV
$ 77di 11,9 7