HomeMy WebLinkAboutBLD11235 Final SFR - BLD Permit / Conditions - 11/6/1981 DORM, Michael I'. #11235
St. Re. 2, fox 21,66A, 'Belfair
08-17-81
Beards Cove, Lot 1, Div. 2
Residence Contractor - Shelton Const.
$32,160.00 Plumbing Permit
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-� BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 7— P/
PERMIT NO. 1.2,3 6--
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
Michael F. Dohm St. Rt. 2 Box 2166A Belfair, Wa. 98528 275-5418
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Lot 1 Div. 2 Beards Cove
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
Shelton Const. Inc. St Rt 1 Box 29 Be — — _#
9-6o PT —
BUILDING Residence
Class of work: 1) NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Home 24 x 40
Valuation of work: $ 1,9 qr // 0. I—q PLAN CHECK FEE PERMIT FEE�o f S U
SPECIAL CONDITIONS: �( !o
BEDROOMS 3 DECKS CARPORT❑
BATHROOMS 1 TOTAL SO. FT. GARAGE ❑ NOTICE
E
NO. OF STORIES BASEMENT El ATTACHED ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. � FIREPLACE ❑ DETACHED ❑ {
CONTRACTOR AFFIDAVIT 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
I certify that I am a currently registered contracjor in WORK IS COMMENCED.
the State of Washington and I am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
Firm SHELTO RUCTION jNC SEASONAL ❑ FLOODPLAIN ❑
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. SN-EL-TC-* 260 PT Date ZONING
PLANNING DEPT.
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
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 therewith. MOTOR VEHICLE PERMIT
Owner _ Date CATION ACC ED B PLANS CHECK BY APPROVED FORMSSUANCE
L CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O.BOX 186 Sheltpn,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items.Mark boxes where applicable.
Name Mailing address—Number,street;city,and Slate Zip code Tel.No.
�. Michael Dohm St. Rt. 2 Box 2166A 9
Owner 8528
2. 3helton Const. Inc St. R 2 98528
Contractor ["6_1 60o
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 Application date
LEGAL DESCRIPTION
Location Lot 1 Div. 2 Beards Cove
Of
Building
NO. PLUMBING FIXTURES FEE
1 WATER CLOSETS
1 BASINS a
1 BATH TUBS
SHOWERS
1 WATER HEATERS
1 AUTO.WASHERS 0"tJ
1 SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer i
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.
- $
• PLOT PLAN
ADDRESS PERMIT NO. o
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R 1/
LEGAL ' o°
DESCRIPTION LOT_ 1 Div. 2 Bec9I'dS Cove BLK ADDITION a
SITE AREA -."Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT `+
Iv N
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE F-I C
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) C
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF 0
N
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS.SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION A&ID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
0
/1
I/We certify that the proposed construction will conform to the dlmensidns end uses show a and that no changes will be made without
first obtaining approval.
2077
-OWNER(S) SITE STRUCTURE(S) (PRINT) UN AUTHORIZED REPRESENTATIVE
NA E fl
DO NOT WRITE Mow THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING