HomeMy WebLinkAboutBLD5865 SFR - BLD Permit / Conditions - 2/19/1980 i
Wayne B. Smith #5865
2-19-80
Lot 144, Section 4, Lake Limrick
Turn right, Main Gate- Lake Limirick -
Follow Dartmoor Drive to
New residence
$22,512.00 Plan check fee:$25.00
Plumbing permit$23.00
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER
!vn . a 6r,,,,, 73 r7N2^Mond2 D/z Sfrc� nv t)�, //as p/ S/ --5' is
DIRECTIONS
TO JOB SITE -i v2N Kai: M,',}✓ Dare
LEGAL • (❑ SEE ATTACHED SHEET)
DESCR. '�oT /�/✓ •- Ser. 7;,•N •� � Grr Kr_ G:/V/12 .e•/t
NAME p IL A ESS CITY 6 STAT ICENSE NO. PHONE
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CONTRACTOR S ruG
USE OF
BUILDING //te %'De-/V C c
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Ale . C sr � r
Valuation of work: $ PLAN CHECK FEE PERMIT FEE 0
rIONS:IAL CONDIT
BEDROOMS L DECKS /p .CARPORT El NOTICE
BATHROOMS Z TOTAL SO. FT.➢`a�u GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT
ATTACHED 11 OR AIR CONDITIONING.
TOTAL SQ. FT. d24 '•"" DETACHED ❑
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 12D DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I aware of the FOR OFFICE USE ONLY
ordinance requirements
the regulating the work for which
the permit is issued and all work done will be in
Conformance therewith. PERMANENT V SHORELINES G
\'+ /`� SEASONAL [] FLOODPLAIN El
Firm V 'C UGY/1•� `. &JIST E.D. NO. S.E.P.A. ❑
By UQVk= Special Approvals IN OUT YES APPROVEDNO
Lic. No. Pu —GC—T-S 6 39D(3 Data `�• /Z/- ZONING
PLANNING DEPT.
SOS
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. Zf rY•"
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY P r•#$CiNECK BY AP ROVED OR ISSUANCE
Owner_---Date . V/1/Y'(" I
PLAN 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.
Name Mailing address—Number,street,city,and State Zip code Tel.No.
1 C., y s"y �fu s c
Owner
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 apPlicanl r AOdress Application date
�3 c'it�/BT of �i✓£ .,Y i y fjes
LEGAL DESCRIPTION
Location
Of
Building '' j.—
NO. PLUMBING FIXTURES FEE
!� WATER CLOSETS 9/
BASINS .�
BATH TUBS f�'/' 6.7
SHOWERS
' WATER HEATERS qq/
AUTO.WASHERS V�
t
/ SINKS ✓
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
/ DISH WASHER 4J/
DISPOSAL
URINAL 't
d
M
e
L�0
i
(Show Street Namet & Property Lines)
INDICATE LOCATION OF MAIN jIHUTOFF VALVE FOR WATER.
PERMIT _ SKETCH IN SEPTIC TANK& DRA114 FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by _-- Permit fee Date pemlt issued Permit number Receipt No.
all
� 6
PLOT PLAN
PERMIT NO.
ADDRESS
w s
LEGAL
DESCRIPTION LOT 141- / BLK '�/- ADDITION
SITE AREA31 �LotT -Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS ` � Sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,ANDSETBACK DIMEN-
SIONS.SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION Aa'D 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 P R-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE SIX 5' OR 1"=20'
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1/We certify that the proposed construction will conform to the dlnlaMidns end uses Shown above and that no changes will be cede without
first obtaining approval.
11G r� P
lJ S-
NAME( 1 OF-OWN 6Rl31 OF M SITE-1-'3 li fTRUC TUREUI IPR INTI SIGNATURE OWNERIEI OR AU TN RIZEO R P ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED /a DATE
DISTRICT AS NOTED 1:
SNaLTON PRINTING