HomeMy WebLinkAboutBLD9106 SFR - BLD Application - 11/24/1980 y
BWIDING PERMIT APPLICATION
MASON COUNTY
nt �
a U r P.O. Box 186 Shelton, Washington 98584
(1P 426-5593
DATE ISSUED
7� rC PERMIT NO. /(L
OWNE NAME MAIL ADDRESS CITY&STATE ZIP PHONE
V "O
DIREC IONS
TO JOB SITE L C
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. /✓
NAME MAIL ADDRESS CI STATE LICENSE NO. PHONE
CONTRACTOR S
USE OF
BUILDING
Class of work: 'NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Wood
eor G " o Q
Valuation of work: $ PLAN CHECK F E PERMIT FEE '
SPECIAL CONDITIONS.
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE
ATTACHED ®� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES I_ BASEMENT U OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE [J 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 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. PERMANENIAr SHORELINES iJ
SEASONAL O FLOODPLAIN ❑
Firm
E.D. NO. S.E.P.A. I
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date 2.j—JEC ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT C
HEALTH DEPT,
WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware gv D BUILDING DEPT.
f the Mason County ordinance requirements for 3 !�
which this permit is issued and that all work done will ROAD ACCESS
be injeolyormance therewith. MOTOR VEHICLE PERMIT
r APPLICA ION ACCEPTED B PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date . BY�
1 .
l
PLAN 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.
1.
Owner
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 Application date
LEGAL DESCRIPTION
Location
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
j 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 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.
(� did is
PLOT PLAN
Jtt.cL ADDRESS �U—w-�.l�—� PERMIT NO. 2110 (v f 8
n D
a o
LEGAL
o
DESCRIPTION LOT BLK ADDITION
SITE AREA o Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 1 1 _ 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 Al"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'
i
0 _
ev
I/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.
NAME(S) OF OWNERS) OF SITE h STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
SHELTON PRINTING