HomeMy WebLinkAboutBLD7477 SFR - BLD Application - 10/1/1980 BUILDING PERMIT APPLICATION
10 MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 /!�
426 5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
vr40— %_ 1�, o. 9 Y 7 pv � <<�,� w'A 95 37i C/26 —o >
DIRECTIONS
TO JOB SITE 1 L, L_✓1�fr,G!G IIC-/�,
LEGAL r (❑SEE ATTACHED SHEET)
DESCR. y V t /VkSu.J L_j< J
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF n �
BUILDING
Class of work: f,NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
S P
0',69 49 A/00fls r % 74O �
/ .Z 47Co 5" = O
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o L70410
Valuation of work: $ PLAN CHECK FEE PERMIT FE d d
SPECIAL CONDITIONS.
BEDROOMS DECKS CARPORT L�'- NOTICE
BATHROOMS TOTAL SO. FT-42901 GARAGE [I
ATTACHED I•� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES,,_,,_ BASEMENT Li OR AIR CONDITIONING.
TOTAL SQ. FT.'r$-O FIREPLACE (I DETACHED 1
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
SEASONAL 11 FLOODPLAIN I
Firm dv.0 Q I A' E.D. NO. S.E.P.A. '
By f 1<-- —' Special Approvals IN OUT YES APPROVED NO
Lic. No. �- �a to Date 9-9 _jv_C ZONING
FFIREMARSHAL
EPT.
OWNERS AFFIDAVIT T. y
KS
I certify that I am exempt from the requirements of the
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for EPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
LIGATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
O ner Date. _ BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS L -o 4— `l 1 PERMIT NO.
a o
LEGAL
u o
DESCRIPTION LOT `� BLK ADDITION 4A I f l6 OK,/ 4 6 u
SITE AREA V y Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS— 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, F;NISH 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES A 5' X 5' OR 1"=20' r
1
j
v
A
I/We certify that the proposed construct d-nWilt.eontgr o the dimensi s r�y shown above and that no changes will be made without
first obtaining approval. ye"I
NAMEIS) OF OWNER(S) OF SITE 6 STRUCTURE(!) (PRINT) 31GKATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED(Z)
PPROVED DATE 11 Cy'
71STRICT AS NOTED &-Ix. / �`5~
HELTON PRINTINS /
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
T Name Mailing address—Number,street,city,and State Zip code Tel.No.
Owner r j�
2.
Contractor il
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signs ur applicant Address Application date
LEGAL DESCRIPTION
Location /
Of L� V
Building 1�
NO. PLUMBING FIXTURES FEE
/ WATER CLOSETS
BASINS r70
BATH TUBS ^ f
SHOWERS
WATER HEATERS d�
AUTO.WASHERS
/ SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Li
Connect to City Sewer
DISH WASHER /
i
DISPOSAL r
URINAL
o c #1 1 N/So•✓ PL. C.
-- (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 Permit fee late pemit issued Permit number Receipt No.
l �7 c9