HomeMy WebLinkAboutBLD4777 Storage - BLD Application - 5/12/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
ATE ISSUED
ZZ-32,0 tZ 06ns--�PERMIT NO. 7 Z
OWNER A�1E y.40( MAIL DRESS Cl & T TE , ZIP � PHONE
Cy • f J
DIRECTIONS
TO JOB SITE
LEGAL (C SEE ATTACHED SHEET)
DESCR. a,- J`
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ADDITION [ ALTERATION F, REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ i�� �� �I PLAN CHECK FEE PERMIT FEE n
SPECIAL CONDITIONS:
(CATION ACCEPTED BY PLANS CHECK BY APP D FOR*I ANCE Type of Occupancy Division
BY Const. Group
v
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories 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 REQUIREDFOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be I conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
�y ey IS NOT COMMENCED WITHIN� DAYS, OR CONSTRUCTION OR WORK IS r '(_j((f� SUSPENDED OR ABANDONED FOR
A PERIOD OFF 120 DAYS AT ANY TIME AFTER
Owner l Date . WORK IS COMMENCED.
PVILArN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH
MAS('*,N COUNTY PLANNING DEPARTMENT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,street,city,and State Zip code Tel.No.
Owner
2.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of?&son County and State of Washington
Signature of appli ) Address 9 10 Appli tlon date
-77
LEGAL DESCRIPTION
Location — —Of t
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS 2 as
BASINS Z 00
BATH TUBS oa
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
I
(Show Street Names & Property Lines)
O0 INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT d� SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
- -DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Appro by Permit fee Date pemit issued Permit number Receipt No.
$ 9 �'�y 7 7 s�3 v