HomeMy WebLinkAboutBLD5439 SFR - BLD Application - 6/22/1977 06 '^S'
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED 7
PERMIT NO.
NAME MAIL ADDRESS CITY&ESTATE ZIP PHONE
OWNER j�/� - f( S:E lY SO
DIRECTIONS
TO JOB SITE a SPh O
LEGAL ,� / (❑ SEE ATTACHED SHEEN
DESCR. (411
1� L"Lr! c`'Q /O 0P Cjelo Ho e°
MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR n� _ (� C d �T
/8
AI
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
®ti57-ruf710A) O&r oQlatisu 60,
Valuation of work: $ v t PLAN CHECK FEE _ �= PERMIT FEE >�?
7.3
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group
Size of Bldg. No. of Max.
(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
ROAD DEPT.
BY
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 u ' Date, 7—Z WORK IS COMMENCED.
P N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.) M.O. CASH
MASON COUNTY Q . NMlN PP;d►PTM FMT
P.Q. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete A:_L items. Mark boxes whare applicable.
Name Mailingadefess—Number,street,city,and State Zip code Tel.No.
,. E BAN i¢v,1 IAe_l 12-1 z- k' Z-
Owner
2. L
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mic.sun County and State of Washington
Signature of applicant Address ,/- Application date
i 2�Z - .�8 �y .S �. to �vr ,q W !O 7-7
-
LEGAL DESCRIPTION
Location
Of
Building on
NO. PLUMBING FIXTURES FEE I'
WATER CLOSETS w
BASINS �
I BATH TUBS �
SHOWERS M
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
/ Connect to City Sewer
DISH WASHER rY)
DISPOSAL
URINAL
e—d
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT Or SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
AppZmey Permit fee Date pemit issued Permit number Receipt No.
lc c�Y �-�°. $ a/. s—o 00/0-7 1 7 16 12�1
Boe Sand and Gravel, Inc. #5439
6-22-77
Hartstene Pointe Div. 10 Lot 43
Contractor
Cabin Virgil Bluhm
773 At ..S" tc�
$18,739.00
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