HomeMy WebLinkAboutBLD7218 SFR - BLD Permit / Conditions - 9/4/1980 c� Gob I
.fungbluth, Mark P. #7218
tie ode n on, Walter (/7ewo&net- 9-4-80
Collins Lake - Lot 15-A /
Plumbing Permit
Summer Cabin Wood Stove
$14,148.00
RUIL)ING PERMIT APPCICAVON
' MASON COUNTY G�
P.O. Box 186 Shelton, Washington 98°384
DATEISSUED
PERMIT NO.
NAME l 1 MAIL ADDRESS _CITY&STATE Z P PHONE
OWNER 't'YhIVI�\ S IIGr` _ire• (On.
DIRECTIONS
TO JOB SITE CD ' 11 (` t:0 ,
LEGAL 17 (L1 SEE ATTACHED SHEET)
DESCR.
NAME MAl ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: 1�L,NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ M E ❑ REMOVE
Describe work:
w sl
L
Valuation of work: $ PLAN CHECK FEE c��, PERMIT FEE D
SPECIAL CONDITIONS:
v
APP ION AC EP BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group
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 BLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
/be
fy that I am exempt from the requirements of the N O T I C E
ct or registration law RCW 18.27, and am aware
e Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED NG. FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
this permit is issued and that all work done will
con ormanc a Wi THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
�y zy X SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owneriill� Date. G WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. 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 Mailing address—Number,street,city,and State Zip code Tel.No.
0
Owner
2.
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signature applican Address Application date
LEGAL DESeRIPTION
Location
Of
Building
NO. PLUMBING FIXTURES FEE
/ WATER CLOSETS
BASINS
BATH TUBS
SHOWERS
WATER HEATERS
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
(Show Street Names & Property Lines)
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 — FOta OFFICE USE
Approved by Permit fee Date perrdt issu Permit number Receipt No.
� v
PLOT PLAN
ADDRESS PERMIT NO.
I� D
A O
LEGAL
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 P"'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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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.
NAME(S) OF OWNER(3) OF 31TE S STRUCTURE(S) (PRINT) NATURE OF OWNE l51 OR AU )RIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED (_� a !
DISTRICT AS NOTED DATE �}
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