HomeMy WebLinkAboutBLD4912 SFR - BLD Application - 9/9/1976 (3) .. �.�..air�i� iJlli.►1.N:1' tF7L'i Tv»r ��_. .. __ �+.a /
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BUILDING PERMIT APPLICATION
MASON COUNTY 4U� VtL
P.O. Box 186 Shelton, Washington 98584 I ft
DATE ISSUED -7 4ZII na
PERMIT NO.
OWNER NAME --r MAIL ADDRESS CITY d STATE ZIP PHONE
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DIRECTIONS �p // yy�� ss fG
TO JOB SITE / �/�/y�` / r 'Ai�i !!/ 6 /l/ .Knf� � •
LEGAL (❑SEE ATTACH D SHEET)
DESCR. Z Q 7_ ,
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR
t
USE OF
BUILDING C
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ U PLAN CHECK FEE PERMIT FEE pz
SPECIAL CONDITIONS: />
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APPLICATION ACCEPTED 13YI PLANS CHECK BY A ROVED FOR IS UANCE Type of Occupancy Division
JC41XR Const. Group
Size of Bldg. No. of Max,
(Total) Sq. Ft.��/G•O Stories f Occ. Load l�
CONTRACTOR AFFIDAVIT T
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.
'irm PUBLIC WORKS
ty
ROAD DEPT.
.ic. 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 REOUIRED 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�ivner �-�.�� `s-��Date. 9 9�G WORK IS COMMENCED.
FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
_WIS! CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION �tc
IV
IMPORTANT — COmDlete ALL Items. Mark boxes where applicable. U
Name Mallingaddress—Number,street,city,and State Zip code a1' Y V
r
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
Signature of applicant �'dellf
dress Application date
/ .-.8� Y' '
LEGAL DESCRIPTrON
Location 3
Of
Building
NO
PLUMBING FIXTURES FEE
2 WATER CLOSETS
BASINS Ov
BATH TUBS
SHOWERS
/ WATER HEATERS v�'
AUTO.WASHERS 2
SINKS !_
FLOOR DRAINS
DRINKING FOUNTAINS
i LAUNDRY TRAYS r
Connect to City Sewer r
DISH WASHER j
DISPOSAL
1 URINAL
I
I
i
- (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.
.L 3
— DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
j Approved by Permit fee Date pemit issued Permit number Receipt No.