HomeMy WebLinkAboutBLD17831 Final Bulkhead - BLD Permit / Conditions - 8/20/2004 MEMO MMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
6// ,r PERMIT NO.
OWNER NAME MAIL EBB CITY&STATE ZIP PHONE
U 27S-0528
DIRECTIONS
TO JOB SITE
ILEGAL _ J ,/�(❑/ n SEE A17 ED SHEET)
DESCR.1 � G� T7 I! �/L�LCICS
CONTRACTOR NI1ME MAIL ADDRESS CITY IE STATE LICENSE NO. PHONE
USE OF Q,d• 7�� ` 7.S=Sid'-'mil
BUILDING
Class of work: WNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
`V / 4" i If
Valuation of work: $ v�0, A CHECK F E t PERMIT FEEIPCP
S
ot "'A CP
SPECIAL CONDITIONS: A.
BEDROOMS DECKS CARPORT❑ NOTICE
BATHROOMS TOTAL SO. FT GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR OONSTRWTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IFOONISTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and 1 the
aware of the FOR OFFICE U' ONLY
ordinance requirements regulating the work for which
the kermit is Issued and all work done will be in
co ormance therewith. PERMANENT ❑ SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
PPROVED
By Special Approvals IN OUT YES A NO
Lic. Date ZONING
PLANNING DEPT. (.As B">!(i SS
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
`. of the Mason County ordinance requirements for
which this permit is I !ed and that all work*wII1I ROAD ACCESS
be conformanc heith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLAN§�V ECK BY APPROVED FOR ISSUANCE
Date, f e
Zr� K VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. CASH
N PRINTING
PLOT PLAN
ADD { D .4 PERMIT NO.
: •
s
0
LEGAL I� L /J
DESCRIPTION LOT _� / BLK ADDITION
SITE AREA L O 0 6 Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS O 0 Sq.Ft. �
INSTRUCTIONS TO APPLICANT c`
THIS FORM NEED NOT BE USED WHEN PLQT.pLAfNS.DlIAWN TO SCALE OF NOT LESS THAN i"-ZO' ARE
FILED WITH PERMIT APPLICATION. (EACH EUrit"ra SITE MUST HAVE A SEPARATE PLOT PLAN.) O,
FOR NEW I11UtLDIN48 OROVIDE THE PO OWING WMATION IN THE SPACE BELOW: LOCATION OF
R O ANp EXIST IMP 1I M.BHOW BUI LWNG,SITE,AND SETBACK.DIMEN-
S ,.iiNNH CONS FIRST FLOOR ELEVATION. STREET ELEVA-
TION PAD 4 4 VICE ELEVATION.ON&* TION OF WATER, SEWER. GAS AND ELECTRICAL
SERVICE LINES.$HOW rOCATION OF SURVEY PINS.S�01111CIFYYTTHE USE OF EACH BUILDING AND MAJOR POR-
TION'THEREOF.
G!/
—� INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE. 5' X W OR 1"-20'
GG
on-0 4q
IE -
I/We certify that the proposed co log"ggefornl to the dlaAan"m snd uses drown above and that no changes will be rinds widmt
fins obtsinino approval.
NAE-Z E A N� ? •A UCTUR f) (PRINT) SIGNATURE OF OWNtR(S) AUTHORIZED
OO NOT WR/TE BELOW ms{rINE
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING
r �
�. TYPE DM
Permit No. pNo. Floors S4 Ftg
Owner CUFF--01 ])ite . j R S
Address Zip 9855224_
Conttactor n
Address . P.O.BDi 271 Bel air ,
Legal Descri }tiR�n } � r r-r-».T. �.
p, vn B{eich Tracts Blro�ck� 2 Tract_34
Direction to pt?o -edt s�tt E 7540 Gravev7Xt fd(gout 1/2
mile . . ,• , , ,• ��_
south of Gr_geview
} } lam..} f�+�,l ���•t e , i i
Plusbiag --r c 1ci1 ver
t�'F•j w opd, Stove
Fireplace :Deck Gerage port f
Basement Loft ' Other —"—
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