HomeMy WebLinkAboutBLD7476 SFR - BLD Application - 10/1/1980 BUILDING PER APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED /_0
PERMIT NO. 71 7
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
Su(410 - 11ILL P 6 �J9.21 l '► g 71 7 -a
DIRECTIONS
TO JOB SITE L a
LEGAL L �/ (❑ SEE ATTACHED SHEET)
DESCR. 1 T -/ T' K ,S'u 13 [�
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR S cZ3 V-
ft
USE OF
BUILDING Re-5
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
S F 8 g, _
/7-24#7 ChAPOST = Cc 3�-- 3 2140
COv E o c// .5 7 do
Valuation of wor $ /, PLAN CHECK FEE�f/�/ d PERMIT FEE Oa
as' --
31.
SPECIAL CONDITION :
BEDROOMS__ DECKS _ CARPORT [.-�' NOTICE
BATHROOMS TOTAL SQ. FT.1 GARAGE ❑
� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
S ATTACHED [
NO. OF STORIES _ BASEMENT Li OR AIR CONDITIONING.
TOTAL SO. FT.jrj60 FIREPLACE ❑ DETACHED ❑
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 SHORELINES
T (� SEASONAL I i FLOODPLAIN L.
Firm u
/ E.D. NO. S.E.P.A. [ I
By --�- C_�_.� Special Approvals IN OUT YES APPROVED NO
Lic. No. _Li�� Date 4"� - ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT EALTH DEPT.
PUBLI 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.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
CATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date . BY
r
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O. CASH
0 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. �`v�,a —fir yz�_o
Owner 1
2.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signat f appli&&" Address Application date
.ir1s ( l.. �ep ►--mow. 47 'I
LEGAL DESCRIPTION
Location
Of LI If 1 O is Sid
Building
NO. PLUMBING FIXTURES FEE
I WATER CLOSETS
BASINS Q ( �00—
BATH TUBS + _
SHOWERS
WATER HEATERS C) 0
AUTO.WASHERS 9
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER Q
DISPOSAL \ \t
URINAL \
C" ---
� -
—1 � (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.
PLOT PLAN
ADDRESS PERMIT NO.
n >
LEGAL '7 bi 9�1
DESCRIPTION LOT BLK ADDITION u
SITE AREA 2'370 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 2'd Sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN V-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 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
O
)
I
i
r
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(3) OF OWNER(3) OF SITE h 3TRUCTUREIS) (PRINT) I NA URE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED _ k-0
DISTRICT AS NOTED DATE
� SHELTON PRINTING