HomeMy WebLinkAboutBLD14965 SFR - BLD Application - 11/28/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 14 q & S
DATE ISSUED i Q
PERMIT NO. 1 t V 1�s
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
SN.E. Hwy #3 Be fair Wa 2
DIRECTIONS
TO JOB SITE Hwy h No to Mason Lake Road then to Everjareen Drive
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Lot Rainbow Lake
CONTRACTOR NAME MAIL ADDRESS CITY h STATE LICENSE NO. PHONE
Same as above
USE OF
BUILDING Residential
Class of work: Ej NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
New Residence
Valuation of work: $ T PLAN CHECK FEE PERMIT FEE /-, , `
24
SPECIAL CONDITIONS: (
BEDROOMS DECKS CARPORT ❑ ` NOTICE
BATHROOMS_ TOTAL SO. FT. GARAGE X 7 J
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED%1 OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED [I
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
I 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 ❑ SHORELINE
SEASONAL ❑ FLOODPLAIN ❑
Firm SHELTON CONSTRUCTION., INC.
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT
YES APPROVED NO
Lic. No. SH-EL-TC *260PT Date ZONING
PLANNING QEPT.
OWNERS AFFIDAVIT EALTH DEPT Q
PUBLIC WORKS
1 certify that I am exempt from the requirements of the FIR
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. BY
0=v
'LAN 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.
,. Shelton Const. , Inc N.E. 22771 Hwy #3 Belfair, Wa. 98528426-1600
Owner
z. same as above
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 Application date
N E 22771 Hb[y #10 Belfair, Wa 081A
LEGAL DESCRIPTION
Location
Of
Building Lot #10 Rainbow w •a e
NO. PLUMBING FIXTURES FEE
1 WATER CLOSETS dL
CIO
1 BASINS
1 BATHTUBS CoMbo
SHOWERS
1 WATER HEATERS O
1 AUTO.WASHERS a0
1 SINKS
Cam`
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
I
1 DISH WASHER
i
DISPOSAL
URINAL
ti
(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 pemit issued Permit number Receipt No.
$ 11-C g � '
PLOT PLAN
ADDRESS PERMIT NO. L ot
0
= o
n >
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LEGAL L'
DESCRIPTION LOT �C BLK ADDITION
q y u
SITE AREA / / Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS j' Sq. Ft.
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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.) O
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. O
r
P)
x
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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1/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
IAI
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) IGNA RE OF OWNER( R AtrTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
I CONVENTIONAL SYSTEM DESIGN FORM - PAGE THREE
• Revised 09/01/92
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DRAINFIRLD LAYOUT DETAIL
IF. . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRAINFIRLD LAYOUT DETAIL CHECKLIST
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Lateral placement within bed ❑
F1Ow splitting details