HomeMy WebLinkAboutBLD0458 Woodstove - BLD Application - 10/28/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO. e'o) "rS�
OWNER "ME MAILADDRESS _ CITY&STATE ZIP PHONE —
DIRECTIONS
TO JOB SITE 111:5 ly LEGAL
SCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR 7-
USE OF
BUILDING
CLASS OF WORK r NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORI ES 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 ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS FIDAVIT CONTRACTORS AFFIDAVIT
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I CERTIFY/THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION 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 CO FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAUlING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
a
VOWNE ^"� r tDATE �'� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE of BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP —3 PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLAN C KEY APPROVE rNCE PERMIT VALIDATION
ZA�C<!+�� BY CASH CK MO TOTAL /, �U
MASON COUNTY
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- aL i s-70 p d Q
Owner
z.
Contractor
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The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signal re of applican Address Application date
LEGAL DESCRIP- ON
S' 4p � C t w
Location
Of .�
Building .S C C d G
NO. PLUMBING FIXTURES FEE
a WATER CLOSETS 0 L
BASINS C
BATH TUBS Z 0
SHOWERS C C
WATER HEATERS G C
AUTO.WASHERS
SINKS 6'
FLOOR DRAINS o Q
DRINKING FOUNTAINS
t '
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
(Show Street Names 8 Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK 3 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by [Permit fee Date pemil Issued Permit number Receipt No.
f-Iv. cl t �e PLOT PLAN
If
DDRESS . (3 t c /`C✓ 13 / f—,{ 1 I JJ 6 PERMIT NO. o
0
EGAL �YB L_ 111_� O If- S 1/4 - S E? c_L rWfl r�3. /LS I GtJtt�� ' D
ESCRIPTION LOT BLK ADDITION
ITE AREA__1 SI 7— -Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS G��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'
SeP 'L
3
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-- "A �� — �� ----- - r°G- fit' s � <- -� V I _c�_--� �` Y-�►
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I/We certify that the proposed construction will conform to the dimensicros-and uses shown above and that no changes will be made without
first obtaining approval. O'
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IAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
(STRICT AS NOTED DATE
6.FL- r n v-1