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Home My WebLink AboutBLD9916 Addition - BLD Permit / Conditions - 8/10/1976 Becker, Fred C. Jr. #9916 8-10-76 McKnight Road, Belfair 29-23-1 Tr 1 NE1/4 NE1/4 Addition Plumbing Permit Issu, $4 ,494 . 00 i W 4 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 DATE ISSUED PERMIT NO. /G OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE • �-- DIRECTIONS TO JOB SITE N C 6- LEGAL s� G _ (0 SEE ATTACHEq HEE-n DESCR. e CONTRACTOR NAME MAIL ADD SS CITY TATE LICENSE NO. PHONE USE OF BUILDING Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: i Valuation of work: $ y9� PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: APPLICATION ACCEPTED BY1 PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy — Division BY Const. Group IF 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 *he permit is issued and all work done will be in Special Approvals Required Received Not Required cr,nformance therewith. ZONING HEALTH DEPT. ,-,rm_._- .__ PUBLIC WORKS ROAD DEPT. ic. N _ __ _ Date i OWNERS AFFIDAVIT I certif• ;at I am exempt from the requirements of the N O T I C E contra::i or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. permit is issued and that all work done will be in conformance Gtherew. h. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS 7/ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER Ownef�� -�-L Date �a WORK IS COMMENCED. 1;: j�I• .. VALIDATIO"v Ct: ",.C: CASH PERMIT VALIDATION CK. M.O. CASH { POT PLAN Flee C. _ Ci / ADDRESS U PERMIT NO. �JEr�q'>cr S/o LEGAL �r C rx DESCRIPTION LOT BLK ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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' C � J I/We certify that the proposed construction will conform to the dirr s and uses shown above and that no changes will be made without first obtaining approval. NAME( OF OWNER(S) OF SITE & S UCTURE(S) (PRINT)- SIGNATgRE7 OF O NER(S) OR AUTHORIZED REPRESENT IVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRI T AS NOTED DATE � 6H LTON PRINTINS 'w MASON COUNTY PLANNING nFPARTMENT P O. BOX 186 Shelton, Washington 98584 PLUMBING PERMIT APPLICATION IMPORTANT — Complete ALL items. Mark boxes whore applicable. Name Mailingaddress—Number,street,city.and State Zip code Tel.No. 57 e T, Z 9 a 3t /0 Owner -- �i�� -i E�T��✓ fj& -z 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 f� Application date LEGAL DESCRIPTION Location Of 4 C Building Z —NO. PLUMBING FIXTURES FEE / WATER CLOSETS '?'re) BASINS BATH TUBS SHOWERS WATER HEATERS AUTO.WASHERS SINKS FLOOR DRAINS DRINKING FOUNTAINS LAUNDRY TRAYS Connect to City Sewer DISH WASHER DISPOSAL URINAL (Show Street Names & Property Lines) INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER. PERMIT df7 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 Recelpt No.