HomeMy WebLinkAboutBLD11672 Cancelled Addition - BLD Permit / Conditions - 1/9/1991 Albedyll, Charles #11672
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Lake Limerick Estates, Division 5, Lot 67
Highway 3, 4 miles to Mason Lake Road, then 2 3/4
miles to Olde Lyme Road, East 780 Olde Lyme Road.
Addition/Bedroom, Living Room & Storage Roam
Contractor:
Self
$18,000.00 Plumbing Permit
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BUILDING PERMIT APPLICATION
MASON COUNTY `
P.O. Box 186 Shelton, Washington 98584
426-5593 p
DATE ISSUED o
PERMIT NO. Ile,41
OWNER /J 1 TAME I1 MAIL ADDRESSCITYSTAT/ 1 Z� PHONE
/W,1
DIRECTIONS �I //�� // Q� .2 ��l S 01A ,� /�� (157r.0
TO JOB SITE 3 1�,. /"ftlOx �hc (CR '�'� /t ( /`�`
LEGAL / _L / (❑ SEE ATTAC SHEET)
DESCR. �Of 67 Ali. S- Lk< Lt'"+a r�CF. e 4s'
I I rrA MAIL ADDRESS` rL CITY S STA LICENSE NO. PHONE
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CONTRACTOR ��1.� e �6,
USE OF
BUILDING ��`�eb'"� �✓�~/ ��'� �— e�e �pey� �,l/ ��I
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work I0 w
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Valuation of work: $ C9 PLAN CHECK FEE ^� PERMIT FE/,_ .S
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. — GARAGE L
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES ' BASEMENT C ATTACHED '- OR AIR CONDITIONING.
TOTAL SQ. FT._SOt FIREPLACE 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
I certify that 1 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 L SHORELINES LI
SEASONAL F FLOODPLAIN L]
Firm E.D. NO. S.E.P.A. I
By Special Approvals IN OUT YES APPROVED No
Lic. No.
Date ZONING
PLANNING DEPT.
E
OWNERS AFFIDAVIT ALTH DEFT.
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 ADLDING D T. // ✓�
of the Mason County ordinance requirements for
which this permit is issued and that all work done will R ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
Z 2ATION ACCEPTED�Y PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. BY
L 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
IMPORTANT—Complete ALL items. Mark boxes where applicable.
/�
Name / Mailing address—Number,street,city,and State Zip code �Tel.No.
C t. 6 J�eS 1 qq3j-
Owner
2. 5t_
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signatur of plica t Address Appl' ation date
Location �LEGA ESCRIPTI
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Of
Building
7P C lie, L t,.,'
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
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(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK 6 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by fj Permit fee Date pemit Issued Permit number Receipt No.
• PLOT PLAN
ADDRESS r L 70 O 019 e Lp—, t4 PERMIT NO. 4 0
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Lj(j;�r,LEGAL / S
DESCRIPTION (� LOT ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT
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THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE Q
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 L'
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.
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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( Ig 10 XIS
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I/We certify that the proposed construction will conform to the dlmensims and uses shown above and that no changes will be made without
first obtaining approval.
✓ r � Atsull
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NAME OF OWNER(S) OF S1TE 6 S RUCTURE(S) (PRINT) IGNATURE OF OWNER(I OR AUTHORIZ D REPRESENTATIVE
ly
DO NOT WRITE BELOW THIS LINE
APPROVED �T �✓
DISTRICT AS NOTED A�� DATE
6HELTON PRINTIN^J