HomeMy WebLinkAboutBLD6413 Addition - BLD Permit / Conditions - 5/16/1980 )fficer, Sherman I. #6413
5-16-80
Colony Surf, Lot 10, Div. 3, B 2
Addition Plumbing Permit
$2,400.00
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BUILDING. PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �-
DATEISSUED
PERMIT NO. 4;�7
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
i v SSS� 1 S
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. 5:; _ Z 3
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING ✓
Class of work: ❑ NEW ADDITION ❑ ALTERATIO ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: "WMZ 1-14 7-C Al le-m C - z
i u s /L C —
e, _ S
s — - 6.
Valuation of work: $ a O-O PLAN CHECK FEE PERMIT FEE,,gpO
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT [7 NOTICE
BATHROOMS TOTAL SO. FT. GARAGE I 1
ATTACHED � : SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_._ BASEMENT LJ OR AIR CONDITIONING.
TOTAL SO. FT- _ FIREPLACE 11 DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT [ I SHORELINES 11
SEASONAL [� FLOODPLAIN 11
Firm E.D. NO. S.E.P.A. I1
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be i conformance th rewith. MOTOR VEHICLE PERMIT
� XAPPLAT/N=BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owne ' Date
BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS `D U �� PERMIT NO. f o
19 D
a o
LEGAL N
DESCRIPTION LOT BLK ADDITION a
nppPo� I /
SITE AREA— �00 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS gY Sq. Ft.
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 A"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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
X `
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.
NAME(S) OF OWNER(S) OF SITE R STRUCTURE(S) (PRINT) SIGNATURE OF OWNER AUTHORIZED REPRESENTATIVE
DO(NO F WRITE BEL THIS LINE
APPROVED
DISTRICT AS NOTED =t.0 DATE 1
r '
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 Tel.No.
Owner .o O /— �tt6 4,A-,4 o 9?1 1, 1#7 2-53 3 0
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
LEGAL DESCRIPTION
Location r `� _ I ` Z
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS Jet tD r'IL��
BASINS
BATH TUBS
SHOWERS WATER HEATERS
HEATERS b
AUTO.WASHERS tC� t
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS i
LAUNDRY TRAYS I \
Connect to City Sewer V1
DISH WASHER j
DISPOSAL
URINAL I�Rn�N t��J) C'XfSJ��A/G
t
(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.
$ ,� , s �� /