HomeMy WebLinkAboutBLD4471 Addition - BLD Application - 4/12/1979 ' BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
CAA .
DIRECTIONS
TO JOB SITE JZ
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. M _ 1
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NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR Z7 S "'
L a w c a M
USE OF
BUILDING (Z
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE
—
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_1_ BASEMENT L, OR AIR CONDITIONING.
TOTAL SO. FT.2� FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 SHORELINES L1
SEASONAL FLOODPLAIN I l
Firm�/42"«�� 1 E.D. NO. S.E.P.A. I.
By Special Approvals IN OUT YES APPROVED NO
Lic. No.Z?q 2/4 L- :2 Date 5/ — 9 —7 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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION AC TED Y PLAN HECK BY AP ROVED F 1 DANCE
Dwner Date .
FLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
J
MASON C011INTY PI ANNING D PAPTMIFNT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes %&tore applicable.
Name Mailingaddresss/s—Number,street,c;ty,and State Zip code Tel.No.
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Owner
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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 ap licant Address Application date
Gl/ 2 A✓a o!% 7
LEGAL DESCRIPTION
Location A. `
Of
Building
NO. PLUMBING FIXTURES rE
WATER CLOSETS BASINS
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS Z t s I
FLOOR DRAINS `„T 1 - IL
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL ( �S
(Show Street Names & Property Lines)
4�
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.
PLOT PLAN
ADDRESS �(/ ; L� /3 p PERMIT NO
/n�55.�.J c IZiL
LEGAL
DESCRIPTION LOT / BILK ADDITION
SITE AREA �'S�� 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 Pl"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.
IINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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.
L:D:[STR
ME131 OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(SI OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
ICT AS NOTED DATE
EE.ON PR!N SIN