HomeMy WebLinkAboutBLD 14944 - BLD Application - 11/18/1983 i
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
N PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE Y'
LEGAL D 1 �� �0 ^ ,�`/� ^ _ / }SEE ATTACHED SWEET)
DESCR. O/C/ / VI`vN ,(`/
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO/.� n PHONE
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CONTRACTOR aN '
USE OF r 1 /
BUILDING D� �f�l A) /4/�J D U IV (�
Class of work: ❑ NEW VADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work �
3 ' WA v 1D�r1.v;;6-
low
Valuation of work: $ o p PLAIN j CHECK FEE PERMIT FEE v
.30 .E 0, QT
SPECIAL CONDITIONS:®06e
- 3o �c,
BEDROOMS IDECKS CARPORTL7 NOTICE
BATHROOMS_— ITOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORI BASEMENT G ATTACHED f OR AIR CONDITIONING.
TOTAL SQ. FIREPLACE Ll DETACHED [:
THIS PERMIT BECOMES NULL AND VOID IF WORK OR DONSTRUCTION AUTHOR-
ONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
/ SUSPENDED ORABANDONED FORA PERIODOF 180 DAYS AT ANYTIME AFTER
I Certify that I am a currently registered contractor in y/J WORK IS COMMENCED.
the State of Washington and I the
aware of the 7 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 SHORELINES C
r SEASONAL :1 FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. -1
BY Special Approvals IN OUT YES APPROVED NO
ZONING
45-
Lic. No. Date /
PLANNING DEPT. //
OWNERS AFFIDAVIT HEALTH DEPT. l-t
PUBLIC ORKS
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. // /3�F(j S$
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 ACCPP ED BY PL S CHECK BY� APPROVED FOR ISSUANCE
Owner Date .
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O. CASH
PLOT PLAN
ADDRESS W l !L/s'wl PERMIT NO.
LEGAL �� T ��, `r O/ �/�V�� �PY/,✓ it " /
DESCRIPTION ��11 LOT BLK ADDITION Pu
SITE AREA 00 Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS �2� -sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' -RE
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,AND SETBACK 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 ELECTRI}:AL
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 5r OR
I
1 a
I
I/We certify the the pro mtru ion will conform to the dimensirnu and uses shown above and that no changes will be made without
first obtaining ap royal.
NAMEl31 OF OWNERl41 OF lITE ! STRUC TU REl41 PRINT) SIGNATURE OF OWNERM OR AUTHORIZED REPR 4ENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DATE
DISTRICT AS NOTED 1
6H[LTON PRINTING
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION I
IMPORTANT—Complete ALL items. Mark boxes where applicable.
Name Mailing address—Number,street,city,and State Zip code Tel.No.
1.
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 applicant Address Application date
LEGAL DESCRIPTION
Location
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS /
BASINS
BATHTUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS /
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
I
(Show Street Names i8 Property Lines)
INDICATE LOCATION OF MAIN S6UTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK 8 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by ]Parmiitf: Date remit Issued Permit number Recelpt No.
QUAAbE, Hans P. #14944
11-18-83
1Wt, M 12-20-4
i
Across '101 from Airport - Cottage Cafell
Contractor!
Pacific Bldg. 898-4131
Addition
I
Shorelines: $30,240.00 Plumbing permit
Setback:
Special Conditions:
Focting' Lfs /<
Setback:
Foundation Walls :
Framing:e,,e 7e-��/
Fireplace:
Wood Stove:
mZvnpt rite ,
Plumbing: p o n r4 0 M FZ E "y " 0 M
Mechanical: m w roo 0 n n °o 0 a o° n n a° 'o m x
Roof : + m r r0 n H " w o rr con
Exterior: W M a „ " wN� Oq w w
i' Interior :¢' a G 8 n �. n o n
Final: �5 9 �!�/ �� n rao 0
o
n .. v. \ C
Stop Work: 1 � � y
Mobile Home: N Im _ ~'
Smoke Detector : 00
Remarks:X/97 a
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