HomeMy WebLinkAboutBLD12520 SFR - BLD Application - 6/2/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STAT,E ZIP PHONE
^ c Sal C/to N WA. '144 19Y
DIRECTIONS If
TO JOB SITE j a
LEGAL 3 y (❑ SEE ATTACHED SHEET)
DESCR. vt
CONTRACTOR NAME MAIL DRESS CITY 8 STATE LICENSE NO. PHONE
USE OF 3� 1341 , S- d 6111)
BUILDING n � �i e ��i !•
Class of work: JP-MEW ❑ AD ION ❑ ALTERATION OF ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Ll
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS- TOTAL SQ. FT. GARAGE []
� ATTACHED Li SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I OR AIR CONDITIONING.
TOTAL SQ. FT FIREPLACE LI DETACHED L
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
/'�ONTRACTOR 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. PERMANENTV SHORELINES
06
SEASONAL D FLOODPLAIN iJ
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEP 3~
PUBLIC 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 D / a
which this permit is issued and that all work done will RiTADACCESS
be in conformance therewith. r MOTOR VEHICLE PERMIT
Owne , Date. ��� LICATIONC PTEb BY �fPLAANNS CHECK B/Y/ BYPROVED FO f�E
lUkd
41
Pl2V CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION M.O. CASH
I
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
BASINS
BATH TUBS
SHOWERS
/- WATER HEATERS
AUTO.WASHERS
SINKS ^►
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
I
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.
PLOT PLAN
ADDRESS } J�J`�s �a�{� PERMIT NO. f o
3Ll
LEGAL /raC // O S'4r VIC��/
DESCRIPTION LOT / BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
p S•G /¢G• 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 BUI LDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA.
TION A"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.
INDICATE NORTH IN CIRCLE A06t GRAPH SQUARES ARE 5' X 5' OR 1"=20'
� r
e
0
I/We certify that the proposed construction will conform tot d�nsi s and uses shown above and that no changes will be made without
first obtaining approval.
` r A24
NAME(S) OF OWNER( OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED ~`
DISTRICT AS NOT DATE
6HE LTON PRIN TINS