HomeMy WebLinkAboutBLD13946 SFR - BLD Application - 5/9/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 � q,, �3
DATE ISSUED
��3 9$46
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE
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DIRECTIONS f'� / [� /q �(
TO JOB SITE R./ Iwl"C G I/ A/Cl N O Fn/-r°�✓�"l Q G✓u�-P!l/�Nh G!1` G�.� �2�� �/e,�Gr 7`.c
LEGAL cc ^� a/ /� (❑ EE ATTACHED SHE T)
DESCR. �G"J.0 ov,P"I r JQC. -3 2 kv G- /V �l Gl{�I�C �� y
V,
NAME MAIL ADDRESS CITY d STATE / LICENSE N . PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ _ �, t� PLAN CHECK FEE PERMIT FEE
C'
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT Li NOTICE
BATHROOMS I TOTAL SO. FT. GARAGE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENTY `�G� ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT.jCM9W FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
/7�ZCONTRACTOR 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 FO OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT[PERMANENT [V SHORELINES
SEASONAL ❑ FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS f
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT. S
Kinn
' permit is issued and that all work done will ROAD ACCESS
ormance therewith. ` MOTOR VEHICLE PERMIT
• v? P LIGATION C PTED BY PLANS HECK BY APPROVED FOR ISSUANCE
Owner Date . a J /1�� c �� BY
PLA HECK VALIDATION K. M.O. CASH ERMIT VALIDATION CK. M.O. CASH
J
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailing address—Number,street,city,and State Zip code �gTel.
No. C,
Owner
2.
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 Application date
li:�2 b G /Gf tit r r o ti w � � 3
LEGAL DESCRIPTION �'�J O r v SZL-3 Ztj1 2V egy tin, 3
Location
Building f -t- Gl " 71 1
Of
6 le0t Y - -I-q4
eA I'T-5
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS
SHOWERS
b
WATER HEATERS ';7
AUTO.WASHERS Gn d
Z SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
J �
DISH WASHER
DISPOSAL \
I�URINAL I h
(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 by Permit tee Date pert issued Permit number Receipt No.
PLOT PLAN
ADDRESS ✓ QX vl �'L /Ort y �iV 4 PERMIT NO. o
f o
LEGAL
DESCRIPTION "e C 32 LOT—frcLt-1 ( t/L f/L('01 y-Il 7hI1 K ADDITION
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS O Sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE S
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 Al"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. 3
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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r
R A Ct �5�7 �►�
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I/We certify that the proposed constr Ion will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
A n
L�a w,
NAM (S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
ff{ J S w.vvL,$ DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GH ELT ON PRINTING