HomeMy WebLinkAboutBLD7158 SFR - BLD Permit / Conditions - 8/15/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED +5iL--
L 1 qDPIESS i PERMIT NO. ZIP PHONE
Q
OWNER NAME 'j MAIL�DL0.✓ L.# le { C�BST �1 L Y► �a • /ll
DIRECTIONS �y
TO JOB SITE tog
LEGAL T h 1 f (❑ SEE ATTACHED SHEET)
DESCR. 3'�v ��— ( 1 r �' S,,E.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
C All
ONTRACTOR
S a cx r- -
USE OF
BUILDING
Class of work: XNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
�Z i , )e- d' to e
ftpc
Valuation of work: $ pd PLAN CHECK FEE G/ PERMIT FEE 3
SPECIAL CONDITIONS:em
BEDROOMS CKS _ •CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE L7
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT X ATTACHED Lj OR AIR CONDITIONING.
TOTAL SO. FA 2—'tO FIREPLACE DETACHED G
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 i 1 SHORELINES
SEASONAL FLOODPLAIN
Firm E.D. NO. S.E.P.A. L I
Special Approvals IN OUT YES APPROVED NO
By
Lic. No. _
Date ZONING
PLANNING DEPT.
/O
OWNERS AFFIDAVIT HEALTH DEPT.
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. M R VE PERMIT
— A ICATION EPTED BY PLAN CHECK BY A (ROVEEFOIS ANCE
vner ate, 7-14
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS L.C�ltr � ) oX ( � f 1'1(Y� PERMIT NO. 0
0
LEGALT^ -E 12. 8.� S t `t
� 4f °
DESCRIPTION LOT BLK ADDITION "
SITE AREA T AREA OF SITE OCCUPIED BY BUILDINGS— Sq.Ft. p
INSTRUCTIONS TO APPLICANT }X_g, a 1yo Z
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LOSS THAN 1"=20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) 74
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS.SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION P"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL Z
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
VV
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
.00el� Iia1 77-1 IE
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
NAMES) OF OWNERS) OF SITE R STRUCTURE(S) (PRINT) 7.GNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED -�
DISTRICT AS NOTED DATE
SHELTON PRINTIN3
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.
S+-a
Owner i
2.
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 plicant Address Application date
LEGAL DESCRIPTION _
Location
Of I
Building AA J Aj
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS
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.
y
Plumb, Richard #7158
8-15-80
�aa3a - au -o -' 0
1.8 mi. from turn-off (Allyn side) west side of road
32-22-1 - Tr. 12 of SE NW
Residence Wood Stove
Plumbing Permit
$49,172.00
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