HomeMy WebLinkAboutBLD160 - BLD Permit / Conditions - 8/15/1979 Ran J. Wsn zd #x.60
Jahn
, t d ` ly S *d Addition
Mason Lake
right t e �.x a.n i ded end road - ' . w a cad ' o r off` m .e - wl. a .eft fenced
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sign can tree.
' inn ' it
/
auiwiti PERMIT APPLICATION
MASON COUNTY
P. ' . Box 18$ Shelton, Washington 98584
4255593
6(4T 3 DATE ISSUE T _ ...'
PERMIT No. /
OWNER NAME MAIL.ADDRESS CI a STATE Z4P €HONE
I 3i
DIRECTIONS p fir*`" _D "t *'A' o
TO oa SITE
. . .. iV Q. 2J2
SEEATTACHED SHEET)
1TRAtT NAME AILADDRES IT> SLATE LICENSE # . PHONE
R
EusE P
L tIN e ' Ai
Class of work: NEW f ADDITION _,.µs ALTERATION N 0 REPAIR i MOVE REMOVE
Descnbe work'
J1
Va9caatiCrn eaf tClk. I t AN !{FEE PERMIT FEE m
SPECIAL CONDITIONS.
tEIRCCTN45
ATI C FiEIT ' ESEPARATE I EPMIT A R QU RED FC7t FtUMB NCs, HE TINC, V NTILATiNO
dt . C7F 5Tt?R}E5,. m__ AaEEIdT R AIR CONDITIONIN+.
TOTAL DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR R AFFIDAVIT IS NOT MMENCED 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 ir WORK IS COMM NCED,
the State of Washington and I am aware of the
ordinance requirements regulating the wwork ₹or which FOR OFFICE USE ON LY
the permit IS issued and all work done wwill be in
conformance therewith, PERMANENT SHORELINES ;.,
SEA5O'AI : FLOODF AtNF
lrtTt ... ED NCI.w S_I P Aa C.
S - EHEALTH
Appval IN 7Y7 PHOVEt NO
tie. No Date
DEPT.
OWNERS AFFIDAVIT PT. ✓ �
PUBLIC WORKS
I certify that I am exempt fr,rn the requirements of the �FIRE t9ARSHAt
contract or registration law RCW 18,27, and am aware LDIf DEP1rf the Mason County ordinance requirements forwhich this permit is'issued and that all cork done will AD ACCESS
r of t i h k M TOR VEHICLE PERM
APP APPLICATION ACCEPTED BY PLANS S CHECIK BY APPROVED FOR ISSUANCE
E} rrser. .. _Date BY
PLAN EDIT VAL TIt N D � , ASH PER3wtI VALi ATIC7 l t MO CACASH
- MASON COUNTY PLANNtNG DEPARTMENT
P„ .BOX 186 Sheltpn,WashWashington 98584
PLUMBING G PERMIT APPLICATION
IMPORTANT Complete ALL istems.Mark boxes where applicable,
Naas .. Ma address Nurs tae¢,street,city,and State Ir rztade Tit.N
M
Owner
ontP ter
The owner of₹hiS tauildsrtg arsd the undertngned agrii to oonforr a app cable laws of Masora ou ty afad State r t Washrngttan
& u t a tic nt Address S ` " r Ap¢ttcatrc date
2r
Location
Cif NOtlilrtitt
, PLEA m LT FIXTUR S FEE
WAY WATER L 7SETS
tASINS
OATH TUBS ,„.
SHOWERS
WATER HEATERS1. .�
AUTO WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS EEE
LAUNDRY TRAYS
Con ecI to CCity Sewer q{ ,�
C3tH WASHER '"
7
0 SPOSAL L s.
URINAL
ow Street Names Property Lines)
a INDICATE LOCATIONMAIN 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 lee Date permit lidued ) Permit number I t NO
PLOT PLAN
ADDRESS PERMIT NO
Pt1ON „ T ELK A € € V
SITE AREAL dC So F . AREA OF SITE 000UP ED BY`S €I . t GS
INTRUCTION5 0 APPLN
THE FORM NEED NOT13 USED WHEN PLOT PLANS DRAIN TO SCARF 9F 9 U4 T€
FIU. TH PS I APPLI AT€ N {EACH BUILDiNG S€`€"I MUST HAVE S t R TF F€t T €A NJ
FOR F $ LOINGS PROVIDE THE FOLLOWING INFORMA ION A T4P4 F S (V C. T€ P€ C F
PPOPOSEOCONSTRUCTONANDEXSTINGIMPROVEWENTS.S € ILDIN a SITE, ET 6C K tt m
SI t S,SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIR LO R FLeta TI 7N, ST` FF ELEVAw.
ON 11 SEWER SERVICE ELSV TION, SHOW LOCATION F ATER, SL W' CHAS P€€ FC.F `RIC� L�
SERVICE LINES.SHOW LOCATI ?N OF SURVEY FINS.SPECFT THE €NSF F FACN S I€ €N N 3 M € 9F€F€ F-
N TFFti
LATE NOR CIRCLE GRAPH SQUARES APE
r'. ,*,,n *4 4t* r' 'a , **fl *I** .. *n* *€*4# ,*
€1We certdy that the p opoesd c neru ffs n w€ o m to the di r bove and that nary changes well b mode 's tns at
hru obte€r€og approval.
+v' OOWN v , O Cma t s t+r ar rr t a TVTOW4t a Ito a r° TI
wI aAl
APPROVED ii 1
DST € N Fb T
s� 4.'