HomeMy WebLinkAboutBLD4595 NEW SFR/GARAGE - BLD Application - 4/4/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O.-Box 186 Shelton, Washington 98584
' - DATE ISSUED //'Z /j7
PERMIT NO. -5 7
OWNER 1p" NAM MAIL'ADDRESS ;
CITY d STATE ZIP PHON/E
DIRECTIONS
TO JOB SITE
LEGAL r IrXSEE ATTACHEDS EEn
NAME MAIL ADDRESS CITY d STATE LICENSE NO. PHONE
CONTRACTOR O W '17 to
USE OF
BUILDING O
Class of work: Pr NEW ❑ ADDIT ON11 ALTERATION ❑ REPAIR ❑ MOVE 0 REMOVE
Describe work: r
1
Valuation of work: PLAN CHECK FEE ZS o PERMIT FEE
9,2. ra
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOJI I.SiSUANCE Type of Occupancy Melon 3
BW1 fl Conat. Group
Size Sq.of Bldg.
[�Xq No. of Stories . Load �Q ax.
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I 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 She Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which permit is Issued andptl allwork done willbe co f anc BWlth. THIS PERMIT BECOMES NULL AND VOID IF WORK OR NSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120.DAYS, OR IF CO STRUCTION'OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 AYS AT ANY TIME AFTER
Owner Date. WORK IS COMMENCED.
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Nam Mailingaddreas—Num 7
r,sttruat,city,and State Zip cc Is Tel.No..
Z;5
Owner
2.
Contractor
The owner of I Ildinq and th untl rei agree to conform to all applicable laws of Mcson County and Slate of Washington
Slgnatura a Addaa �G � A pllution date
7
ILEGAT DESC IPTION
Location
Of � r
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS p--O
ASINS Q2rd
BATHTUBS I"O
SHOWERS
WATER HEATERS d—O
AUTO.WASHERS
SINKS a`-A
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
-'99nnect to City Sewer
DISH WASHER p-{J
DISPOSAL
URINAL
(Show Street Names & Property Lines)
/ INDICATE LOCATION OF MAIN SHU OFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK& DRAIN FI LD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Appr �`� �� sPermit tee Date parnit issued� Permit numberReceipt No.