HomeMy WebLinkAboutBLD5721 SFR - BLD Permit / Conditions - 8/10/1977 Fields Dean 52 �r #5721
8-10-77
lst Addn Ayock Beach Blk 6 Lot 3
Residence PLUMBING PERMIT ISSUED
$26,800.00
1.2 ,Zi- 7
PERMIT
yAID �Y EXpIF:�TfAN
NULL & 9� eY
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BUILDING PIRMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED 'Z7 7
PERMIT NO. 1 7�1
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
s i 55 SJ
DIRECTIONS
TO JOB SITE -t f
LEGAL ( SEE ATTACHED SHEET) I
DESCR. o t- 3 �p 0 Cfi — Ci
CONTRACTOR NAME MAK ADDRESS CITY&STATE LICENSE NO. PHONE
I RA
Q v
USE OF
BUILDING S
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ a� PLAN CHECK FEE PERMIT FEE // G
SPECIAL CONDITIONS:
2(CATION ACCEPTED BYJ PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy » _ Division
BY Const. Group /z I
Size of Bldg. No. of Max.
(Total)Sq. Ft. y Stories Occ. Load
CONTRACTOR AFFIDAVIT 0�
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. Q
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
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be i conformance there /ith. 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 Date. WORK IS COMMENCED.
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Cerrtplete ALL items. Mark coxes where applicable.
Name Mailingaddress—Number,street,city,and State Zip code Tel.No.
9' s
Owner IF
2. -
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Sig r of applicant Address AppllCat n date
Az .
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L G L D CRIPTION ��� /�_ /'
Location �' — --Fs� � � K
Of , ,ff
Building s G k
j6 IL
NO. PLUMBING FIXTURES FEE
WATER CLOSETS MO
BASINS F'Q
BATH TUBS
SHOWERS a.
WATER HEATERS I U
/ AUTO.WASHERS d d
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER p J
DISPOSAL
URINAL
L � (Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT p CJ 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.
$ 7,7. ` %7 �7a/