HomeMy WebLinkAboutBLD0415 SFR - BLD Application - 6/24/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
NA ME MAIL ADDRESS CITY&STATE
OWNER � ZIP PHONE
DIRECTIONS
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LEGAL ,
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DESCR.
CONTRACTOR NAME AIL ADDRESS C &STATE LICENSE NO. ZIP p �t
J cc b � tll(L. C-e-k- S ZQ 37Z �172-
USE OF
BUILDING !' I\)!er LV fro (EL-(4
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
BEDROOMS ✓� DECKS _,� CARPORT--!- NOTICE
BATHROOMS L SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTALSQ.FT. GARAGE �_ CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED„� THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SQ.FT. FIREPLACE ;U5&y4- DETACHED COMMENCED
ABANDONED FOR WITHIN
180 DAYS,8 DAYF CONSTRUCTION
TIME OR WO K IS SUSPENDED
OR
PERMANENT � SHORELINE /Jc'�
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CE TIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REG TRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
RE IREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN ONFORMANC TH EWIT NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OB AINING APP V O U G DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT..
OW ATE �� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES No YES No BUILDING VALUATION g ?s o4
HEALTH /t PUBLIC WORKS FEE
PLANNING i FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
ff SHORELINE
Al
ii iN L"t i r iP6ANNI
fS O C)
'iY►^M �'/� r,� :3 ? Tr PLUMBING DO
" MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
`N ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY CASH CK MO TOTAL
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.
Owner ,
r� 37'Z a 72
2. l
Contractor
The owner of this building and the ndersigned agree to conform to all applicable laws of Mason County and State of Washington
Signatur of lica /,�e�, 7 s lication date
c�x � fZ. cApp
LEGAL DES I TION
Location
Of /' s - i
Building L2e
NO. PLUMBING FIXTURES FEE
WATER CLOSETS G'
BASINS12— C'
ATH TUBS
SHOWERS p G'
WATER HEATERS O
AUTO.WASHERS G4 v
SINKS C rn
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS r _
�t L
Connect to City Sewer n
DISH WASHER r�U I u QC
i
DISPOSAL
q1
URINAL l)
'c FF L, ;PA SS
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT 61 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.
$ �>
ICHRISTMASTOWN PRINTING
PLOT PLAN
ADDRESS IQ��� `2 PERMIT NO. f
;7
n a o
LEGAL
a
n
DESCRIPTION �L LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT h
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE 73
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 Al"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 ARE 5' X 5' OR 1"=20' (.
R
y
•e
1
I/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.
NAMEISI 0 1& STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
%HELTON PRINTIN3
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