HomeMy WebLinkAboutBLD4040 SFR - BLD Permit / Conditions - 11/18/1976 Kitchens, Richard D. #4040
11-18-76
Deer Creek Loop
N2 NWT N E4 36-21-3
Plumbing Permit issued
Residence
$35,000.00
-7d 40Q
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BUILDING PERMIT APPLICA TIO
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO. 'via �ld
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS 1-�OJi Z-
TO JOB SITE ,eGt .r- -44,P 1 iZ., llvt, JL 6Gi/OslrP .!'/G� .4G J LA6,r.<
LEGAL y Oe SEE ATTACHED SHEET)
DESCR. C- D / L.�L-psi R !9 r�sL%�0'W s.
CONTRACTORF
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING Afi--,v,4-r"7tF�oC:v�G-
Class of work: )'NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE 44 PERMIT FEE
SPECIAL CONDITIONS:
LIGATION ACCEPTED BY PLA� CHECK BY APP OVED FOR ISSUANCE Type of Occupancy Division
Const. � Group .Z
Size of BldgM i �'� No. of Max.
(Total) Sq. Ft. Stories L Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered Contractor In RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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
Owner ('• Date. 741 WORK IS COMMENCED.
PL
Ap CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY
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
J
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
DISH WASHER
DISPOSAL
URINAL
--- (Show Street Names & Property Lines)
-- INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT f C Cj 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.
$ j � d
CHRISTMASTOWN PRINTING