HomeMy WebLinkAboutBLD5519 SFR - BLD Application - 7/15/1977 • BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED_?ZI 7 7
PERMIT NO. J ��
NAME r MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER 0, I , r�, ut�` oAK nee Pt 5 vi. A-c4 a
DIRECTIONS
TO JOB SITE „r.•r! ". _.... . .
LEGAL X,t/�(fJ,SEE ATTACHED SJE T)
DESCR. 'p,, s
CONTRACTOR NAME MAI CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: XNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
fa
Valuation of work: $ PLAN CHECK FEE e PERMIT FEE
.2- 74
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
' BY � �� Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
1 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 0 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.
which this permit is issued and that all work done will
be in conformance herewith. 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
Owner rma ' Date.,, 77 WORK IS COMMENCED.
R,VAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
MASON COUNTY MANNING nFP.APTIAAFNT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,street,city,and State Zip code Tel.No.
J
1. G.w/iit It /.Zz,s" OGt� *i^�e 74
Owner %Ci7 7(1
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 --l-Address _ Application date
/Lt/3 e�ff tR" PL .fN
LEGAL DESCRIPTION
Location G K` 'e y low 2. S-<, ?J— 60% C-d
Of
Building zo ;k IF 1,4ti io,,. W4 /jloa — S✓�•»Jcf wcJf o� C-A A cPe ti
Rey wrr,•�
NO. PLUMBING FIXTURES FEE
WATER CLOSETS O O
BASINS C p
BATH TUBS G O
SHOWERS OO,
WATER HEATERS O O
AUTO.WASHERS &a
SINKS C+O
FLOOR DRAINS
DRINKING FOUNTAINS —-- •3 V�
LAUNDRY TRAYS
Connect to City Sewer
j DISH WASHER 0 O
DISPOSAL
URINAL
(Show Street Names & Property Lines)
0 O
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT Q() SKETCH IN SEPTIC TANK & DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by Permit fee Date pemit issued Permit number Receipt No.