HomeMy WebLinkAboutBLD9954 SFR - BLD Permit / Conditions - 8/16/1976 Holert, Bertha
#9954
8-16-76
Lakeland Village Div. 3 Lot 1
Residence Contractor
Lumbe rmens
$20,380.00
Plumbing Permit issued
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BUIWING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS OWNER CITY&STATE
Alew OL s1" ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL (❑SEE ATTACHED SHEET)
DESCR. pf" A�E�L//� V/��G'F �//tfoiy�Oo�✓f� /� L s✓ s
CONTRACTOR NAME MAIL ADDRESS CITY&STATE ' LICENSE NO. PHONE
.BUILDING .��/DE/✓�jq�
Class of work: 9311NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
ftr �'or'/�yz
Valuation of work: $ 3roi. PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLI ATION ACCEPTED PYl PLANS CHECK BY APPFJQVED FOR In Type of Occupancy Division
�cJ B Const. Group —�
Size of Bldg. No. of Max.
CONTRACTOR AFF{DAVi (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 eviare 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
����N/�N1. p� � � HEALTH DEPT �G
Firm PUBLIC WORKS
By a Tf�f�F„[ ROAD DEPT.
Lic. No. /l/�'El/✓ ��3/�r Date 1
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
which this permit is issued and that all work done will VENTILATING OR AIR CONDITIONING.
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
Owner SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Date. WORK IS COMMENCED.
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTMENT'
P.0. Box 400 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
1. LEGAL DESCRIPTION
Location
Of N S
Building N S
E W side of feet E W from intersection of
Sect. Twp. Range
NO. PLUMBING FIXTURES FEE NO. GAS APPLIANCES FEE GAS PLUMBING
/ WATER CLOSETS Q� EACH UNDER 60 MBTU SEWER SEPTIC TANK
BASINS
EACH 60 TO 120 MBTU
a
BATH TUBS 2 EACH 120 TO 200 MBTU
SHOWERS EACH 200 TO 500 MBTU
a
WATER HEATERS G EACH OVER 500 MBTU
AUTO. WASHERS
SINKS i
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer SERVICE CONNECTION
DISH WASHER
G/
DISPOSAL
URINAL
Distribution System
By Special Permit
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR
GAS AND WATER. SKETCH IN SEPTIC TANK & DRAIN
PERMIT PERMIT FIELD LOCATION OR SUBMIT ON OTHER SKETCH.
FIELD INSPECTION
Date By Remarks
Mailing address — Number, street, city, and State —Zip codeTel. No.
Owner
2.
Contractor
The owner of his uilding and the undersigned agree to conform to all applicable laws of.Mason County
Signature of p ant Address Application date
�
_ DO NOT WRITE IN THIS SPACE.— FOR OFFICE USE
Approved by r Permit fee Date permit issued Permit number Receipt No.