HomeMy WebLinkAboutBLD10657 SFR and Bulkhead Application - BLD Permit / Conditions - 5/27/1981 BUILDING PERMIT APPLICATION ObeOS
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
00 (� 426 5593
1 DATE ISSUED
OWNER f NAME MAIL ADDRESS PERMIT NO.
CITY&STATE ZIP f
PHONE
DIRECTIONS Qa p �( yw O2
TO JOB SITE C s Di O L
LEGAL
DESCR. _ V Ot✓ � (❑ SEE ATTACHED SHEET)
oF'r, fi.� �!/ glJa A).
CONTRACTOR NAME MAIL ADDRESS
CITY&STATE LICENSE No. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ffpp /f
a/L zeL&
Valuation of work: $
PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS
CARPORT ❑
BATHROOMS TOTAL SO. FT. GARAGE ❑ NOTICE
NO. OF STORIES BASEMENT❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑ OR AIR CONDITIONING.
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR.
IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
I Certify that I am a currently registered contractor in
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER
WORK IS COMMENCED.
the State of Washington and I am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑
SHORELINES ❑
Firm SEASONAL ❑ FLOODPLAIN ❑
By
E.D. NO. S.E.P.A. ❑
Lic. No. Special Approvals IN OUT YES APPROVED NO
Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
I certify that I am exempt from the requirements of the PUBLIC WORKS
contract or registration law RCW 18.27, and am aware FIRE MARSHAL
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will
be in conformance therewith. ROAD ACCESS
MOTOR VEHICLE PERMIT
Owner Date APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
BY
'LAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO.
o c
= s
LEGAL o
DESCRIPTION LOT BLK ADDITION u
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.PSHOW D EWER SERVICE ELEVATION., FINISH OI SHOW LOCATITOURS OR AGE ON,OF FIRST
WATER�EWER, GASELEVATION,
ANDSTREET
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'
,/We certify that the proposed construction will conform to the dimeraio+ns and tales shown above and that no changes will be made without
first obtaining approval.
NAME(a) OF OWNER(a1 OF SITE 6 STRUCTURE(S) (PRINT) AIGNATURE OF OWNER(S1 OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
DISTRICT APPROVED
AS NOTED DATE
ORELTON PRINTING
32`� 36 RCE( 157FP. 12D
'2
Gov'-r:--�oT-2"• •. .
LEGAL DESCRIPTION: TRACT 1
The South 100 feet of the North 800 feet of •Government Lot 3,
Section 16, Township 22 North, Range 1 Test, W.M. , Mason County,
Washington; which lies Westerly of the Westerly right-of-way of
Secondary State Highway 14-B.
SDBJECT. TO easements, reservations and restrictions, of.record.
EXCEPT 'public roads, if any. _IN Mason County, Washington. V
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t #10657
ROBERTS, Lee M. & Lois J. 05-27-81
Follow SR 302 E. from Allyn, WA for 3 miles. Property
fronts on SR 302 and 3 mile road sign in on East boundary
of the property.
So. 100' of the North 800 ft. of gov't lot 3, Sec. 16,
Twp 22 N, Rge 1 W, lies Westerly of the rt of way of
secondary St. Hiway 14B
Residence Shoreline Exemption
plumbing Permit
$48,841.00