HomeMy WebLinkAboutBLD5007 Final Addition - BLD Permit / Conditions - 6/6/1977 SYikeleather, H. W. #5007
9-28-76
Collins Lake Div. 1 Lot 46
Addition & Alteration Plumbing Permit issued
$7,680.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO. SOU 7
OWNER N ME -MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
RDYL
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. 0 A
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
iJ ,
USE OF L
BUILDING
Class of work: ❑ NEW ADDITION LTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
r
5—3
Valuation of work: $ 17,1� •�� PLAN CHECK FEE PERMIT FEE
L
SPECIAL CONDITIONS:
Ade
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVE FOR ISSUANCE ype of / Occupancy Division
BY Const. �% Group j
L�
Size of Bldg No. of Max.
(Total)Sq. Ft. �r� / Stories / Occ. Load
CONTRACTOR AFFIDAVIT lJ
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 QME
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 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance there ith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
�J `� IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
/wner ate_
2` `i� SUSP NS D OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION Cl{. M.O. CASH
MASON 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.
` p d. - a y 9aa
Owner
z. iLl F
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of w-son County and State of Washington
Signature f plicant Address c Application date
LEGAL DESCRIPTION
Location 3 —--
Of
Building
NO. PLUMBING FIXTURES FEE
l WATER CLOSETS �tv
BASINS 4`Lw
t
I BATH TUBS
SHOWERS
WATER HEATERS G�
/ AUTO.WASHERS C
/ SINKSA 0-
Lam'
i 1
FLOOR DRAINS ,
DRINKING FOUNTAINS
j LAUNDRY TRAYS
Connect to City Sewer
' DISH WASHER
i
DISPOSAL
URINAL
(Show Street Names & Property Lines)
-ert✓
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
i Approved by Permit fee Date pemit issued Permit number Receipt No.