HomeMy WebLinkAboutBLD0191 Addition - BLD Permit / Conditions - 7/17/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 rl- L(
DATE ISSUED__
PERMIT NO. /g C
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER �� �\Y �_���}\�r1�< �-e u� F � . �xt: ��'c� �����.��- ���� • �-�,�Z� Z`��-�3�3�
DIRECTIONS
TO JOB SITEty
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. ;s�v
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW DDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe wor�
Valuation of work: $ PLAN CHECK FEE PERMIT FEE j Z�
_S B D 0
SPECIAL CONDITIONS:
BEDROOMS DECKS . T CARPORT L I NOTICE
BATHROOMS ITOTAL SO. FT. tk' GARAGE ❑
ATTACHED L] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. T.�ZCC? FIREPLACE ❑ DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR 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 that I am a currently 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 i l
Firm E.D. NO. S.E.P.A. L
g Special Approvals IN OUT YES APPROVED NO
Lic. o. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. �.M- �-r
l 1L!-j
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT. /�
which this permit is issued and that all work done will ROAD ACCESS
be in conformance Aerewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner -- Date .
BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
`Naame Mailing address—Number,
(street,
�city,and State Zip code Tel.No.
Owner GE.O. V\c2 " ._ �'r V �.4p�, "Fra `s �i:"�. \JC\'1�i1` l� z Z`l'-'a�
.C1Z
2. .0
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 ,1c, y" Application date
LEGAL DESCRIPTION
LocationOf
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
` BASINS O
BATH TUBS O O
SHOWERS
WATER HEATERS
AUTO.WASHERS c
SINKS -0
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT /5' 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.
HOLMGREN,, George #0191
Haven Lake, Lot 115 7-17-84
P. 0. Box 748
Belfair, Wash 98528 275-5337
Contractor
Self
Addition Adding 1Ox20 addition (bath & bdrm)
$7500.00
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