HomeMy WebLinkAboutBLD4397 SFR - BLD Application - 3/3/1977qw"41-�
UILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRE S CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE bitZj� c K S' 9 V4a w — tk)i—S / b F- It'o ev — /
LEGAL J (❑ SEE ATTACHED SHEET)
DESCR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR S'L F
USE OF
BUILDING "I�L S -1)-X:NGL5
Class of work: I'g.NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
y6o � .zd= _
Valuation of work: $ PLAN CHECK FEE _ U PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FgR ISSUANCE Type of Occupancy Division
kW Const. Group
jar vim— 5 I
Size of Bldg. No. of Max.
(Total) Sq. Ft. 91,0 Stories f Occ. Load /Q
CONTRACTOR AFFIDAVIT
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 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
whic this permit is issue nd that all work don ill
bef i C Onf Ce there 1. 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 ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
O w n ele-. Date. q 7-7 WORKIS COMMENCED.
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH
i MASON r01JNTY PI. ANNINO nPPART.A 1FMT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,streo►,city,and State Zip code Tel.No.
iow vex
Owner
2. S 4< u
Contractor
The ow of this buil �nd the undersigned agree to conform to all applicable laws of M,;on County and State of Washington
Sig r
ure a II Addras!� Appli n dat
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LEGAL DESCRIPTION y
Location — - ---
Of
Building
NO. PLUMBING FIXTURES FEE
I WATER CLOSETS G
L BASINS d-t)
BATH TUBS
SHOWERS b-0-
WATER HEATERS Q-()
AUTO.WASHERS
' SINKS Q�
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER &15
DISPOSAL
URINAL
(Show Street Names & Property Lines)
4�
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 Permit fee Date pemit issued Permit number Receipt No.