HomeMy WebLinkAboutBLD10550 SFR - BLD Application - 5/8/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL AID ESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE f
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. l o,7 .� L�/ //`'I�R/C
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR E /� u /1/3 3 7
USE OF
BUILDING 41--_C
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ �� `� GO PLAN CHECK FEE S�o� PERMIT FEE Ga
,�33. .-
SPECIAL CONDITIONS:
BEDROOMS I DECKS 1,101VA5 CARPORT ❑ NOTICE
BATHROOMS (TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT AO� O IREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME 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 I❑ oZ®Q
SEASONAL FLOODPLAIN ❑
Firm�/ (�/��!>�/` /t/f 0� w/ s// E.D. NO. S.E.P.A. ❑
By XLX 146 7 Der Special Approvals IN OUT YES APPROVED NO
Lic. No._� �/ 32 3 /Ic T Date ZONING
PLANNING DEPT.
j P
OWNERS AFFIDAVIT HEALTH DEPT.
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.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
(CATION A EPTED BY PLANS CHECK BY ROVED FOR ISSUANCE
Owner Date. Y
LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
. . . MASON COUNTY PLA.MN iNG nFPA-RTMFNT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,street,c;Yy,and State Zip code Tel.No.
Owner ��7
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 Applicatio date
�'1�
LEGAL DESCRIPTION
Location Of Z
f
Building 1-
NO. PLUMBING FIXTURES FEE
WATER CLOSETS OV
BASINS O
BATH TUBS
SHOWERS
WATER HEATERS 2— ge7
AUTO.WASHERS
SINKS O`
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER 0�
DISPOSAL
URINAL
R/w,MIr
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved b Permit fee � Date pemit issued Permit number Receipt No.