HomeMy WebLinkAboutBLD9520 Final SFR - BLD Permit / Conditions - 2/8/1980 Empolen, John & Welch, Mary #9520
3-7-78
Collins Lake Lot 28 Div. 2
Contractor
Jerry Wright
Residence
Plumbing Permit issued
$22,000.00
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED �b�R
IT NO.
OWNER NAM MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
of n /m I Y (�D ELQ4 i iW b 5 Lv a A I
TO JOB SITE
LEGAL (U SEE ATTACHED SHEET)
DESCR. C. �. Li `d `1 g b\u 4� C6 Lu N s kykA_ �
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING eS
Class of work: CK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
U v U
ki
Valuation of work PLA CHECK FEE Wit! PERMIT FEE
�2 � i 4 s b
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
I 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 REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be it onformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
t2 1,_�� SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Ow er Date. J 6 WORK U., COMMENCED.
PLAN 61HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY PLANNING DEPARTM.FNT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mallingaddress—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 Mason County and State of Washington
Sig ature of applicant / Address Applicatlon date
(� l�(•!�k % 1—(;/ & z ac_�o X Ja 7 T -a 9- 76
L GAL DESCRIPTION
Location
Of
Building
NO. PLUMBING FIXTURES FEE
WATER CLOSETS
BASINS
Z BATH TUBS
SHOWERS
/ WATER HEATERS a
AUTO.WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
/ DISH WASHER
DISPOSAL —
URINAL
Ly (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 — FOR OFFICE USE
Approve by Permit fee Date pemit issued Permit number Receipt No.