HomeMy WebLinkAbout12153 - BLD Permit / Conditions - 3/15/1982OWNER
DIRECTION
TO JOB SITE
LEGAL
I DESGR.1
CONTRACTO
USE OF
BUILDING
Class 0
k' E
Describe work.
NAME
Y'•.
>IZ'/
NAME'.
P,O, Box 186
MAIL ADDRESS
MAIL ADDRESS
ADDITION ALTERATION
T
Shelton, Washington 98584
426-5593
CITY & STATE.
�Ic
DATE ISSUED
PERMIT NO,
y
Z I'P
ATTACHED SHEET)
CITY A STATE LICENSE NO
REPAIR MOVE REMOVE
PLAN CHECK FEE,
JAL CQNEDTIONS,'
TAI'rof,:
HACE
T tACHE.Ei
COED
NTRAGTOR AFFIDAVIT
I cer'tlty that I am a currently' regrrrrerrsd contractor in
r�,ne Stair,., of Waah,hingio,^ Pit C rai". aV:are of the.
orrUnance requirem.enIF regulwirg :lr,e Nail).. for '!Meta
the permit is ii sued and all wor`, done will he in
r"C;nfcerr`..:;1ara e; trceoTc ith
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements 01 the
contract or registration law RCW 18.27. and am aware
of the Mason County crdtnancaa requirements for
w,'I,r;h this permit is issued and that all work done will
he in conformance therewith
PERMIT FEE
PHONE
PHONE
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OP AIR CONDITIONING -
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR
IZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED
PE HM AAN E N T
SEASONAL
E Li NO
5{=�•; al A ppf ovals
ZONING
PLANNING DEPT
'HEALTH DEPT
C WORKS
FIRE MARSHAL
'BUILDING
ROAD ACCESS
MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY
U
SHORES I1
FLOODPLAIN
S.5 P.A
OUT
PLANS CHECK BY
LY
YE,; APPROVED NO
APPROVED FOR ISSUANCE
BY
ERMIT VALIDATION f CK. M.O- CASH
MASON COUNTY PLANNING DEPART ENT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
NO
Nao t,
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Mdslinp address — Number, ;ttreet, city, and State
7'TC'r, /J2/ r)7cr'a °l;,/ °j r m. y �''•
actor
net ;at ₹cars Vuitdtng and Utr= undersigned agree to conform to an appecable taws of Mason County Inch Slate of Wa>nngto c
applicant ., ,.. Address
Location
Of
BastIding
GAL DESCRIPTION
re —S./ r1'i , i q.
PLUMBING FIXTURES
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
•
FEE
Zip code lei NO
::.4€ e.7?
Application date
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
SKETCH IN SEPTIC TANK 8 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH
DO NOT WRITE IN THIS SPACE - FOR OFFICE USE
Permit tee T Dale pain+t tssu
Receipt No.
PLOT PLAN
ADDRESS CL -Y %?'1 1 1
LEGAL
DESCRIPTION LOT
SITE AREA Sq. Ft
PERMIT NO.
BLK ADDITION
AREA OF SITE OCCUPIED BY BUILDINGS Sv. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN I",2O' ARE
FILED WITH PERMIT APPLICATION, LEACH 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 A^'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.
INDICATE NORTH IN CIRCLE
pro 00
ng approval.
GRAPH SQUARES ARE 5° X 5` OR 1"-,20'
he dlmsnsi 1ni and uses shown above and that no changes will be made without
DISTRICT
DO NOT WRITE BELOW THIS LINE
APPROVED ,
AS NOTED;,,.
DATE
I Ralliit \b. I2i5 ___F,t;sisioace ^b•
Opr'r j l c r rpn C;arry ^_
2orri5 A,yccnap Sc>>ir i, Ronr
(asport,
Olympic Trails, Lot 96
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