HomeMy WebLinkAboutBLD19636 Windows and Doors - BLD Application - 12/4/1986 I
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS Y&STATE ZIP PHONE
�OWNER 2 l / ' S J/9
DIRECTIONS TO JOB SITE �. �^ %ej0""
LEGAL %r'rlCT 4i= k.� rl�M T
DESCR. $'_C C' I j W
NAME MAIL ADDRESS CITY&STATE LIC NSE NO. ZIP PHONE
CONTRACTOR �v
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR ✓ MOVE REMOVE
WORK ✓
DESCRIBE
WORK LYG� t10E/ L %g!c Q
41
BEDRO S � DECKS CARPORT N TICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
�( COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ✓� ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL_
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTR ION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT ING VAL FROM THE BUILDING DEPARTMENT. C / APPROVAL THE BUILDING DEPARTMENT. Q (�
X OWNER L Z' 11 DATE o•` J' � lr' X BY DATE `'✓r
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION e7 2
YES NO YES NO /.. .3
HEALTH n-l— PUBLICWORKS FEE
PLANNING `( FIRE BUILDING PERMIT 9 � L`
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP — PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING 6
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CH K BY APPR VED�081S UANCE PERMIT VALIDATION �-
a ®
BY 'cC CASH CK MO TOTAL
MASON COUNTY 1
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 Tel.No.
/ i
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
Signatur of ap licant Address Application dale
OV
If GAL DES RIPTION
Location
Of .�
Building S
NO. PLUMBING FIXTURES FEE
WATER CLOSETS O
BASINS .— kw_ 2?1
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS \,
SINKS p ZA
FLOOR DRAINS ��-36
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
T
DISH WASHER
DISPOSAL
URINAL
n = I
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT 130� 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.
$
CHRISTMASTOWN PRINTING
PLOT PLAN
ADDRESS !„, I' twa I of PERMIT NO. a
/ � f o
DESCRIPTION �QT t L�T`� ifteemmolfto I- sjBLK �kc,iti p ADDITION
SITE t�i/�` C,0
SITE AREA �4. Ft. AREA OF SITE OCCUPIED BY BUILDINGS_ IC/7`T Sq.Ft.
loco 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 ARID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL `I\
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
V _
'fINDICATE NORTH IN CIRCLE GRAPH SQUARES A4E-S' X S' OR 1"
.x
y
O
1f,
T
Illy
ILL
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.
:DhauI V, 1 yz►'-tiE uUQt4S
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING
_ J