HomeMy WebLinkAboutBLD4665 SFR - BLD Application - 5/10/1979 BUILDING PERMIT APPLICATION
MASON COUNTY .
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED O —' 79
PERMIT NO.
OWNER 4NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE
LEGAL //.- �J (❑ SEE ATTACHED SHEET)
DESCR. C_ n r- 7U {4la.t R� Pa�j L..6,w-q fI r.!. -Z
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
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USE OF
BUILDING
Class of work: �.NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE /J PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS ' CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE Q—.�w
ATTACHED f$/ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_t BASEMENT LOR AIR CONDITIONING.
TOTAL SQ. FT. IZ 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
co formance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN [IFirm ++.r'
E.D. NO. S.E.P.A. [IBy Special Approvals IN OUT YES APPROVED NO
Lic. No. Date �3�` �Q ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. q /
PUBLIC WORKS
I certify that ram exempt from the requirements of the FIRE MARSHAL
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 AC EPTED BY PLANS CHECK BY A ROVED FO ISSUANCE
Owner � � � � '` Date. �"" �U '�y _
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH
v �
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.
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
Sign ure of appl cant Ad ress Application date
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LEGAL DESCRIPTION
Location f �
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS a—p
BASINS b d
1 BATH TUBS
SHOWERS 0-v
WATER HEATERS 0 0
I AUTO.WASHERS !
SINKS
FLOOR DRAINS
v DRINKING FOUNTAINS
LAUNDRY TRAYS /G�'•
Connect to City Sewer `
ST rDISH WASHER (�
DISPOSAL
URINAL
y
2'S• �,
Af4AQ J 4-41tt�
(Show Street Names & Property Lines)
0'CJ
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
Approv by Permit fee Date pemit issued Permit number Receipt No.
. PLOT PLAN
ADDRESS n, p �y�Y 147 PERMIT NO. o a
f
LEGAL
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0
DESCRIPTION LOT 7 L) BLK ADDITION l��ay3«.�L.,�y; u
SITE AREA 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, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION P"ID 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.
e*NDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
i
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I/We certify that the proposed construction will conform to the dime 1f ,and uses",above and that no changes will be made without
first obtaining approval. �" �, """; "'
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NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) �IGNATUR .OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING
1