HomeMy WebLinkAboutBLD1621 SFR - BLD Permit / Conditions - 3/17/1975 /G 2/
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BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE_ -�1-��_ _�
`/ n D
Applicant to complete numbered spaces only. PERMIT NO.1�
u
JOB ADDRESS
A i:ai !�l `� 42&'//7
D
LEGAL ( SE. ATTACHED SHEET)
1 DESCR.
OWNER MAIL ADDRESS ZIP PHONE
2
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
AXZirrTF'Cf OR DESIGNER MAIL ADDRESS PHONE"" LICENSE NO.
4 r/ r1
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
8 ceq A U /1 r,
USE OF BUI DING
7
1
8 Class of work: '11�1 NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work: P �. c
10 Change of use from
Change of use to
11 Valuation of work: $ -� ,r �D
PLAN CHECK FEES, PERMIT FEE
SPECIAL CONDITIONS: Type of Occupancy 1
Const. Group l Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. �p0 Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTE4 BY: PLANS CHECKED BY. APPROVED FOR ISSUANCE BY: Zone Zone Required ❑Yes []No
\a
No.of OFFSTREET PARKING SPACES:
Dwelling Units Covered Uncovered
N O T I C E Special Approvals Required Received Not Required
ZONING.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT.
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Specify)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisio of any other state or
local law regulating construction or the perfor ance of construction.
SI4, 216,
OF CON TO
OR AUTHORIZED AGENT (DATE)
SIGNATURE OF OWNER IF OWNER BUILDER DATE
'LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHEL.TON PRINTING CO.
MASON COUNTY PLANNING DEPARTMENT
P.0. Box 400 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT —Complete ALL items. Mark boxes where applicable.
1. LEGAL DESCRIPTION
Location S � 7
N
Building s
E W side of _— , feet E W from intersection of
Sect. Twp. __— _ Range
NO. PLUMBING FIXTURES FEE NO. GAS APPLIANCES FEE GAS PLUMBING
WATER CLOSETS j EACH UNDER 60 MBTU SEWER El SEPTIC TANK
+� BASINS EACH 60 TO 120 MBTU
BATH TUBS EACH 120 TO 200 MBTU
SHOWERS EACH 200 TO 500 MBTU
WATER HEATERS EACH OVER 500 MBTU
! AUTO. WASHERS \ r' Lj ',e r
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer SERVICE CONNECTION
DISH WASHER -
DISPOSAL
URINAL
ell
Distribution System
By Special Permit
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR
17O GAS AND WATER. SKETCH IN SEPTIC TANK & DRAIN
l PERMIT PERMIT
FIELD LOCATION OR SUBMIT ON OTHER SKETCH.
�
_ FIELD INSPECTION
Date By Remarks
_ Name Mailing address — Number, street, city, and State Zip code Tel. No.
1. O Jv
Owner C �a
2 too
Contractor
\ The owner of this building and the undersigned agree to conform to all applicable laws of.Mason County
Signat licant Address Application date
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DO NOT WRITE IN THIS SPACE_— FOR OFFICE USE
App d by Permit fee Date permit issued Permit number Receipt No.
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