HomeMy WebLinkAboutBLD4912 SFR - BLD Application - 9/9/1976 \_T, Cr c 'ra,..yi T✓
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
s/ 7
PERMIT NO. 4" 91,
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE L
ri/ ,tve�►�,( s� r ;r. J v e/�.B / .r. y �'(.�� AO.:,� • s��/,rf
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Q / i(1 '4/ `.
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: )(NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
.4'0 -t .2 5" wit,rG ,B1�i7Bl��� �2 S C
Valuation of work: $ -09 c PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
l U O
APPLICATION ACCEPTED BY1 PLANS CHECK BY AF ROVED FOR.I�NCE Type of Occupancy Division
- Const Group
✓LlI4 �LCC�,�
U Size of Bldg. No. of Max.
(Total) Sq. Ft.lzle C Stories Occ. Load
CONTRACTOR AFFIDAVIT l�
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
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR�iv ner��..�.'.!J�s Date_ s�f'—/'G WORK ISCOMMENCE COMMENCED.
FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. I M.O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Comolete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,street,city,ano State Zip code Tel.No.
Owner
2.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of M4 son County and State of Washington
Signature of applicant Addresses 1 �f Application date
LEGAL DESCRIPT N
Location j ---
Of
Building
NO. PLUMBING FIXTURES rFEWATER CLOSETS BASINSBATH TUBS
SHOWERS
/ WATER HEATERS
AUTO.WASHERS „Z
I SINKS
FLOOR DRAINS
i DRINKING FOUNTAINS
/ LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
i
I DISPOSAL j
URINAL
I
I
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT 3 c-�y SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
—__ ON OTHER SKETCH.
Z3
- DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
�Ap�pmved by Permit fee Date pemit issued Permit number Receipt No.