HomeMy WebLinkAboutBLD10772 SFR - BLD Application - 6/12/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED to
PERMIT NO. /077-A
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
C-TE-Q-Co n)T�SyE N. ,9{-3S 1 S 3 A-V*SE �Eu-EV'U>- 8",6 �F6-�603
TO JOB SITE DIRECTIONS SITE E Tiff -tIYA &-tit, J(OQTM a W0JD eff-Rt 4 N1t�s Of 69+4 CL ","
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LEGAL (❑ SEE ATTACHED SHEET) T
DESCR. .L 0r. ' A�� / . N/ f R! G/
NAME MAIL ADDRESS CITY&STATE^ LICENSE NO. PHONE
CONTRACTOR
USE OF e
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
DU!t-D A G4 Si n1 1N T" s S
STW 0 FburrbAn oo S Et L Ruoff SC—P71G 7WK A24fA/P &YO
2 AfTF-kPO W711.LS 1 (3A� T177ONE
�-' O yFi Y
s?0 007 X 8 * 6DD
Valuation of work: $ O PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: r ` co
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES ATTACHED ❑_/ BASEMENT ❑�Od OR AIR CONDITIONING.
TOTAL SO. FT.—T4& FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR 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. PERMANENT(PERMANENT (j SHORELINES I I
SEASONAL FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date Z NI
PLANNING DEPT.
OWNERS AFFIDAVIT HrALTH DEPT.
PU 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
4 be inbe 'n conformance therewith. MOTOR VEHICLE PERMIT
/ APPLICATION ACCEPTED BY PLANS CHECK BY APPRO FOR ISSUANCE
Qye Date. /2-A! BY
0-42 . 1 4:2A. I
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. 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.
Pie-Ca mv.,a u, 5 3s 153 Av-f- SE &&�—✓UE 9T006 74-' 03
Owner
i
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 applica Address A plication date
04�6aeljzld�L- 3s /sAv� cll 98 i z, s
LEGAL DESCRIPTION
Location
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS D
l
BASINS
BATH TUBS
' SHOWERS 0 C)
r
' WATER HEATERS
SINKS d
/ 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 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.
g' da4/.1-e/
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r
#1242-C LUA.L DESCRIpTIoN nv 11/6I80
, PETER CnNTESSE TRACT
That Portion of Aevernment Lot 3, Section 5, Tnwnshin 22 North, Range 3, blest,
VI.M. , Mason County, Oashi-noton, more oarticularl,y described as follows :
A circular tract of land havinr a radius of 60 feet, the radial center of
which is narked blv an .i.ron Pipe which is located 505.53 feet west.and 1580.28
' feet south of the 'Meander Corner at the northwest corner of Government lot 4,
in said Section 5, said Meander Corner being an existing steel axle.
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PLOT PLAN
ADDRESS PERMIT NO. 4 0
a v
v
LEGAL a
DESCRIPTION LOT BLK ADDITION 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 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'
1/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(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6H ELT ON Pfi1N TINS