HomeMy WebLinkAboutBLD9672 Final Kitchen Addition - BLD Permit / Conditions - 9/29/1978 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 9M4
DATE ISSUED
PERMIT NO..
OWNER AME MAIL ADDRESS _ CITY&STATE ZIP PHONE
DIRECTIONS t 'f
TO JOB SITE Z,i.t ee%k, 6. /V AI
LEGAL (❑SEE ATTACHED SHEET)
DESCR. Gj 2. T/ �1 c% C7�''_: LD 7- 1
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CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING T/ciA_)
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ n.z. PLAN CHECK FEE PERMIT FEE r_
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY1 PLANS CHECK BY APPROyED FOR ISSUANCE Type of Occupancy _ Division
BY Ad,X-,`,I/ Const. Group
Size of Bldg. No. of Max
CONTRACTOR AFFIDAVIT (Total)Sq. Ft. a Stories Occ. Load
PERMANENT SEASONAL E.D.NUMBER
1 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
By ROAD DEPT.
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
which this permit is issued and that all work done will VENTILATING OR AIR CONDITIONING.
be i� nformance t erewi h. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
Owner
Date 7- `�� WORK IS COMSUSPENDED MENCED.
ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON ('01INTY Pw,,NNINr nFQ.ARTMFNT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — 10ornpiete ALL Items. rAark L)exe , uhare applicable.
Name Mailingadd,ess—Number,st: et city,and State Zip code Tel.No.
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Owner —_—� i�O— -- ---Z---
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2.
Contractor
The owner of this building and the undersigned agree to contmm to all applicable laws of ki,.:;o!)Cov-,'y and State of Washington
Signatur plicant Address
Application date
LEGAL D SCRIPTIOW 7 �f
Loc 'on —
Of
Building ) G - CL�/ !!.• / ��Z L�Ae
NO. PLUMBING FIXTURES FFE
WATER CLOSETS
BASINS
BATH TUBS
i
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS <�=
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 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.
1.
Kantzer, C. Jack #967,2
7-2-76
Tract 2 of G.L. 6, 29-22-1
Kitchen Addition
$4,320.00
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