HomeMy WebLinkAboutBLD8164 SFR - BLD Permit / Conditions - 7/15/1975 JCnram, HerD f�51U4
7-15-75
11 acres in NWµ, 36-21-3
Construct Residence
$18,998.00
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A
BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATES-1 �
Applicant to complete numbered spaces only. PERMIT NO.
,JOB ADDRESS
LEGAL #P/ �-�j X' /G'C 1^C S p C Y`T r GYv\ Q /r�,,) �CJ
1 DESC R. T ([:]SEE ATTACHED SHEET)
OWNER ! MAIL ADDR SS ZIP PHONE
2 N/ Y, b . CS „ -oQ- 6 34^ SLv
CONTRACTOR MAIL ADDRESS PHON F. LICENSE NO.
3 X t/ 1 L571, /C> —1L/ �1 - O/- �G
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF�BBUUILDING
8 Class of work: NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work: 3 C
10 Change of use from
Change of use to
11 Valuation of work: $ �5 �p PERMIT FEE Fly,v / o PLAN CHECK FEE
SPECIAL CONDITIONS: Type of Occupancy
Const. Group Division
Size of Bldg. No.of Max.
(Total) Sq. Ft. Stories Occ. Load ! Q
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSI)ANCE BY. Zon@ � Zone Required ❑Yes ❑NO
No.o1 OFFSTREET PARKING SPACES:
Dwelling Units Covered Uncovered
N O T I C E Special Approvals Required Received Not Required
ZON1NC.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT.
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Soeclfy)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
NATURE OF CO AC R OR AUT O IZE A iT DA E
RE OF OWNER IF OWNER BUILDER DATE
=CK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
—TON PRINTING CO.
MASON COUNTY PLANNING DEPARTMENT
P.0. Box 400 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
LEGAL DESCRIPTION
Location or V
Of NsIf NS
Building
Sect. Twp. Range
`` GAS PLUMBING Ir'[V
NO. PLUMBING FI Xl�URES FEE NO. GAS APPLIANCES FEE I/V
WATER CLOSETS JO EACH UNDER 60 MBTU SEWER SEPTIC TANK
z BASINS EACH 60 TO 120 MBTU
BATH TUBS 1,_So EACH 120 TO 200 MBT
SHOWERS iJ(/ EACH 200 TO 500 MBTU _
1 WATER HEATERS ��(/ EACH OVER 500 MBTU
-AUTO. WASHERS
SINKS V
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer SERVICE CONNECTION
1 DISH WASHER , V
DISPOSAL
URINAL
Distribution System
By Special Permit
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR
GAS AND WATER. SKETCH IN SEPTIC TANK & DRAIN
PERMIT �,R/�UTO PERMIT FIELD LOCATION OR SUBMIT ON OTHER SKETCH.
I r r✓
FIELD INSPECTION
Date By Remarks
Name Mailing address — Number, street, city, and State Zip code Tel. No.
Owner
ConContractor ---�
The owner of this building and the undersigned agree to conform to all applicable laws of.Mason County
Signal re of applicant Address ApppI c tion date
rtJ t— .✓ Q / F 7
DO NOT WRITE IN THIS SPACE.— FOR OFFICE USE _
Approved by Permit fee Date permit issued Permit number Receipt No.