HomeMy WebLinkAboutBLDAB-1 Remodel - BLD Application - 5/2/1977 1
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED 4-28-77
PERMIT NO. 14 13— /
NAM / MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER A n, s ,j �/1//0A1 tv
DIRECTIONS Cf
TO JOB SITE
LEGAL �/7 (❑ SEE ATTACHED SHEET)
DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY&STATE ICENSE N PHONE
_S LJ �6 a or /sY 7 x� 87(-
USE OF ,22 COA; :'iNgl
BUILDING �Q t�,� koe l,)V a
Class of work: ❑ NEW ❑ ADDITION CkATTERATION EPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
/0 �
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPR6VED 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
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.
which this permit is issued and that all work done will
be in conformance therewith. 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 ".—L)Bate. WORK IS COMMENCED.
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
-- - -- MA."o-Z*A COUNTY PLANNING DEFARTNAFt.,UT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,stree%city and State Zip code Tel.No.
�. /G '0
Owner
2. S1�6t? C`�rv`f/u lT�✓ Is��1 _
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 Applil tlo;,a
����.->✓
LE AL DESCA4PTIONA-
Location `��.-•tiZ L-Lt-A--� �S_a-e, �' � 4-`�
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
I
Connect to City Sewer 1
DISH WASHER
DISPOSAL
URINAL
(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 fee Date pemit issued Permit number Receipt No.
9.00 4-28-77
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