HomeMy WebLinkAboutBLD11360 Addition - BLD Permit / Conditions - 9/3/1981 ROBERTSON, Vic #11360
P. 0. Box 1162, Belfair 09-03-81
1 mile from Oak Patch Lake, Tract 8, 15-23-2 of Survey
2/12
Addition Contractor - Self
(Adding bathroom
and kitchen 18'X221)
$11,880.00 Plumbing Permit
• BUILDING PERMIT APPLICATION
MASON COUNTY.
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT N0. L//.3
OWNER NA IL ADDRESS CI 8 TATE ^ ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL / �i �1 (C] SEE ATTACHED SHEET)
NAME MAIL A ESS CITY 3 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW AADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: t
Q�41 4a
01
Valuation of work: $ !JJ ��Q i PLAN CHECK FEE _ 67
CZ PERMIT FEE
SPECIAL CONDITIONS: O
i
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT._ GARAGE ❑
ATTACHED L� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I i OR AIR CONDITIONING.
TOTAL SQ. F FIREPLACE ❑ DETACHED I l
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 C SHORELINES
SEASONA ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. [:I
By Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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
f the Mason County ordinance requirements for BUILDING DEPT.
hich this permit is issued and that all work done will ROAD ACCESS
be in r I erewith. MO OR VEHICLE PERMIT
P LI TION CEPTE BY PLANS CHECK BY APPROVED FOR ISSUANCE
Own r Date. ,Z e
IN to
PL N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O CASH
F
PLOT PLAN
ADDRESS PERMIT NO. o 0
n >
a o
LEGAL a
n
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 ARID 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 NOR IN IRCL GRAPH SQUARES ARE 5' X 5' OR 1"=20'
W'PAIz-'2_ i r V.
y
V
f
I/We certify that the proposed construction will conform to the diment l and use; own above and that no changes will be made without
first obtaining approval. I
U
L`
NAME(S) OF OWNERISI OF SITE & STRUCTUREISI (PRINT) pNAT E OF OWNERM OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOA THIS LINE
APPROVED
DISTRICT AS NOTED �.3 DATE
6HELTON PRINTIN3
MASON COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
N Mailing address—Number,street,cit nd State Zip code Tel.No.
Owner
z.
Contractor
The owner of this building and the dersigned agree to conform to all applicable laws of Mason County and State of Washington
Signa*turofp Address Application date
LEGAL DESCRIPTION
Location
Of
Building
NO.. PLUMBING FIXTURES FEE
WATER CLOSETS O'O
BASINS r U 0
BATH TUBS !Lf
SHOWERS �.d
WATER HEATERS
D AUTO.WASHERS
/ SINKS eydi
r FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
(Show Street Names & Property Lines)
OTC
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT 0-6 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.
1 3&0