HomeMy WebLinkAboutBLD13043 Addition - BLD Application - 9/21/1982 } BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADD S CITY 8 STATE ZIP PHONE
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LEGAL /- c (❑ SEE ATTACHED SHEET)
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NAME MAILIADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW 1< ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ p PL N CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
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BEDROOMS {DECKS — CARPORT ❑ NOTICE
BATHROOMS I TOTAL SO. FT. GARAGE [
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I J OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE I DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
1 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 [] SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
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
of the Mason County ordinance requirements for BUILDING DEPT._ .4/ W s ftz IV
which this permit is issued and that all work done will ROAD ACCESS
be in conform rice therew' h. MOTOR VEHICLE PERMIT
��/, LIGATION AC EPT D BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. I I,�• - BY -
PL HECK 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
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailing address—Number,street,city,and State Zip code Tel.No.
Owner
2.
Contractor
The owner of this building and the undersigned agree
aa_gr"ee to conform to all applicable laws of Mason County and State of Washington
Signature f applic I " Address � � .\C � � / Application date
EGAL DESCRIPTION
Location
Of r
Building V
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS
SHOWERS 13
WATER HEATERS
AUTO.WASHERS 4�` �' S•'
A v
SINKS rJ
FLOOR DRAINS 1
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER I s( P
DISPOSAL
URINAL
(Show Street Names 8 Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT �rC' 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.
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9$.
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