HomeMy WebLinkAboutBLD8217 SFR - BLD Permit / Conditions - 7/28/1975 Sobotka, James R. #8217
7-28-75
Springwood, Lot #4
Residence
$25,000.00
712 ahs
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BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqtcn 98584
DATE_'l- 4
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Applicant to complete numbered spaces only. PERM IT NO. �Z
4
JOB ADDRESS w
1 LEGAL /L�!/J� 7t (❑SEE ATTACHED SHEET)
DESCR.
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OWNER MAIL &DDRESS ZIP PHONE
z _3 oz 7 2 z.3 a
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUILDING
8 Class of work: 14 NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work:
i
10 Change of use from
Change of use to
11 Valuation of work: $
PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: Type of Occupancy
Const. Group Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BV PLANkC11C1E1 BY. APPROVED FOR ISSUANCE BY. Zone Zone Required ❑Yes ❑NO
F
No. of OFFSTREET PARKING SPACES:
welling Units Covered Uncovered
N O T I C E Special Approvals Required Received Not Required
ZONING.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. ✓ iJr
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER fSoeclfy)
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 provisions of any other state or
local law regulating construction or the performance of construction.
(ITTGN+VURE OF CONTRACTOR OR AUTHORIZED AUTHORIZED AGENT (DATE)
1
SIGNATUREOF OWNER 1I OWNER BUILDER) ((DATE)
"N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH )7�
SHCLTON PRINTING CO. I
PLOT PLAN
ADDRESS,, , W66 c{ p � y
—� PERMIT NO.
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LEGAL f,[DESCRIPTIONy a
,, BILK ADnDITION.�O,
SITE AREA/_�t
%, / LOT 231- Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 1dQn --Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE
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 A"'D 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.
E— INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
NAVE(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
STRICT AS NOTED � � �� � DATE '7
1
I,
MASON COUNTY PLANNING DEPARTMENT
P.0. Box 400 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
1. LEGAL DES IPTION
Location
Of N s
N S
Building
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 C EACH UNDER 60 MBTU SEWER ❑ SEPTIC TANK ❑
BASINS EACH 60 TO 120 MBTU
BATH TUBS _ d EACH 120 TO 200 MBTU
SHOWERS EACH 200 TO 500 MBTU
1 WATER HEATERS EACH OVER 500 MBTU
AUTO. WASHERS S�
SINKS r
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer SERVICE CONNECTION
DISH WASHER 5^6)
DISPOSAL d
URINAL
1`v
Distribution System
By Special Permit
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR
GAS AND WATER. SKETCH IN SEPTIC TANK & DRAIN
PERMIT PERMIT
FIELD LOCATION OR SUBMIT ON OTHER SKETCH.
/
FIELD INSPECTION
)ate By Remarks
Name Mailing address — Number, st eet, city, and State Zip code Tel. No.
Owner — —
2.
Contractor —
The owner of this building and the undersigned agree to conform to all applicable laws of.Mason County
Signatur if
pplica Address Applic on to
_J_
NOT WRITE IN THIS SPACE — FOR FOR OFFICE USE _
�oveV Per fee Date permit issued Permit number Receipt No.