HomeMy WebLinkAboutBLD10557 Final Addition - BLD Permit / Conditions - 4/26/1983 " . BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
—
PERMIT// PERMIT NO.y� C�Q[� ('� /7C� c
LA 13 NAME MAISTMR*r 1o3 GBF—LTF �TT /8 O 75-681 J
E ZIP PHONE
OWNER i D 1
DIRECTIONS 1 • ,
TO JOB SITEr SEE AITAr- IFD S{-{6E 1
LEGAL. C7! G(.J �J • 7 (�Z C(, ( SEE ATTACHED
DESCR HEET)
NAME MAIL AD RESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR eP /
c� I
USE OF y_
BUILDING SIN LE FAMILY f-bME
Class of work: ❑ NEW XADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
ADD ON 'TO E ISTfN4 13ED2ooM hOb ND b A E)ATt4 oor`-t
Valuation of work: $ r� ,� PLAN CHECK FEE PEF MIT FEE i610
SPECIAL CONDITIONS:
BEDROOMS (DECKS CARPORT NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED C] SEPARATE PERMITS ARE REQUIRED FOR PLUMB( G, HEATING, VENTILATING
NO. OF STORIES BASEMENT :] OR AIR CONDITIONING.
TOTAL SO. FT. � FIREPLACE E DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,ORIFCC NSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORAPERIODOF180 AYS AT ANYTIME 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. PERMANEN [ SHORELINES
SEASONAL FLOODPLA �" i
Firm E.D. NO. S.E.P.A. . ' -
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONIN
OWNERS AFFIDAVIT
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MA L
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 R CESS
b in conforgianc therewith. MQjQR VEHICLE PERMIT
•I D,, - APPLIC T N EPTED Y PLANS CHECK BY APPROVED FOR ISSUANCE
Owna QiL � ^"�� Date. 28 g� B
N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION 3K:' M.O. CASH
Order No. Q-75111 EXHIBIT NV
DESCRIPTION:
The South 190 feet of the North 410 feet, all as measured along th West
right of way line of the Old Bremerton Highway, of the following d scribed
tract:
The Northeast quarter of the Northwest quarter of the Northeast 0 krter
and thejast-20 feet of the Northwest quarter of said Northwest qu rter
of the Northeast quarter of Section 29, Township 23 North, Range 1 West,
W.M., in Mason County, Washington$
1
EXCEPTING THEREFROM county road known as Old Bremerton Highway. j
ALSO,. EXCEPTING TH&REFROM the West 202 feet as measured along the rth r
line thereof.
i
F Posf OFFICe
� Cif ono
E -bu81 hK ,DRIUEwAY IS f1pPRpx. J I�o2Yb u+
FRc Np�c �RRKiaa to{ ou
AE 11JE>T SIDE OF: "Ydte
ROAD I
DUR {ouSE
PLOT PLAN
ADDRESS '- PERMIT NO. i
i o
0
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA - 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'•n20' kRE
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.DIN EN-
SIONS. SHOW EASEMENTS,FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AI"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRI Al_
r 1 SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJORPOR-
TION THEREOF.
OINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE
'' Ili . y `) in
n
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1
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i
1/We certify that the proposed construction will conform to the dimemiDns and was shown above and that no changes will be m4 de without
first obtaining approval.
NAMEIS) OR OWNER(SI OF SITE a STRUCTUREISI (PRINT) 31ONATURE 0o OWNERISI OR AUTHORIZED RtPRI SENTATWE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHIKLTON pRiNTIN6
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 c Dole Tel.No.
.D u 8)A K D, 0 . ST A R RT 3 1, FSK 63 BGLFA I WA 98 9568/
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
Signal of applica _ Address Appli anon to
LEGAL DESCRIPTION
Location
Of
Building
NO. PLUMBING FIXTURES FEE
I WATER CLOSETS
BASINS
r BATH TUBS OU
_
SHOWERS
WATER HEATERS
AUTO.WASHERS /
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
`�'JRhW
LAUNDRVTRAVS I �I 'DaNip
Fq(rtA
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
WAP=R VALUE
La
F /� t
OLb ULFAI2 4W
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN S UTOFF VALVE FOR WATER.
PERMIT 3 SKETCH IN SEPTIC TANK 8 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by i Permit lee Date pemit 169ued Permit number Recelpt No.
-- s // 6 o? -�/ /ion jr
3 . MASON
5sh and Birth Stree€x
' • '. O. Box lab
MESSASE DATE 5 113 /81 REPLY DATE
TO
D. A. Dubiak
Star Route 3, Box 63
Belfair, Washington 98528
In regard to plans for ,your addition to your
residence, the Building Inspector will require
complete structural plans for this vroiect
Also we note the plum
bing
p ing permit was overlooked
and the $11.00 fee has not been paid. It will
also be necessary to complete the enclosed plot
I plan -- show the existing building and the
addition and distances from property lines roads,
etc. We would appreciate your attention to
i these matters. Thank you.
SIGNED ,.U ✓ Vera Elliott SIGNED
s i� ce-tom Administrative Asst.,
Redifcrm0 4S 473 SEND PARTS 1 AND 3 WTTH CARBON INTACT-PART 3 WILL BE RERMNED WRN REPLY.
Poly Pak(50m )4P473
DETACH AND FILE FOR FOLLOW-UP
Pam- �
��nn� �c J L�� y�t trG��li t t
JUL 2
REGIONAL PLANNING
d
DUBI;.K, D. H. #10557
St. Rt. 3, Box 63, Belfair 07-24-81
1
See attached map - 29-23-1
Addition - 162sq.ft.
Contractor - Self
$4,860.00 Plumbing Permit
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