HomeMy WebLinkAboutBLD13618 Addition - BLD Application - 2/22/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 '3 DATE ISSUED
PERMIT NO.
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OWNER NAME MAIL ADDRESS CITYBST E ZIP PHONE
727414/411' r,? i x , s 4e
DIRECTIONS
TO JOB SITE
LEGAL 1 (O SEE ATTA E SHEET)
DESCR. & }' p — JA
NA MAIL ADDRESS fCITY TATE LICENSE NO. PHONE
CONTRACTOR �l
USE OF
BUILDING
Class of work: ❑ NEW ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ 9 PLAN CHECK FEE PERMIT FEE f
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SPECIAL CONDITIO :
BEDROOMS a- (DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE LJ
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_ BASEMENT i:l OR AIR CONDITIONING.
TOTAL SO. FT O FIREPLACE ElDETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IFCONSTRUCTION OR WORKIS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS 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. PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN 11
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNIN PT.
OWNERS AFFIDAVIT HEALTH DjPT
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 o7
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
X be in conformance therewith.
J MOTOR VEHICLE PERMIT
Q/�fLL1+ea`'"""' � � Z^a A LIGATION ACC�PTfD BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date ,
""
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PVK CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CAST'
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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.
r 12 ,2 - Co
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
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LEGAL DESCRIPTION
Location
Of
Building
NO.. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATHTUBS I —
SHOWERS
WATER HEATERS �1r.
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
/ DISH WASHER
DISPOSAL
URINAL
Air V
(Show Street Names 8 Pr
INDICATE LOCATION OF MAIN SHUV
PERMIT SKETCH IN SEPTIC TANK 6 DRAIN HE
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by Permit lee Ta
pemlt Issued Ponnit numberOilg $ ' as 83 �36 �; �`
/�/f/ A '� PLOT PLAN
ADDRESS .//.. Y /-/ �O// LCA�'ZC-GLGG�!-LyYI/ /C�Gf. PERMIT NO. a
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D ' S
LEGAL' L r'.�OVA S
DESCRIPTION LOT /g (- U: n 1. BLK ,St �, L ADDITION ,•,
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS _Sq.Ft.
INSTRUCTIONS TO APPLICANT
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THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE
FILED WITH PERMIT APPLICATIOW (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 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.
t,
OINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"-20'
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I/Wa certify that,tha propoad construction will conform to the dimensiom and usa shown above and that no Charges will be mode without
first obtaining oppruval.
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NAMC(1)OF OWNER(S) OF SITE \ STRUCTUREl11 (PRINT) 1 N TURF OF OWNE Ia) OR AUTHrH RI P E� SEN9ATIV
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DO NOT WRITE BELOW THIS LINE
APPROVED
ISTRICT AS NOTED DATE
iNCLTON rRINTINO Y
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