HomeMy WebLinkAboutBLD11649 Final Office/Den Addition - BLD Permit / Conditions - 11/30/1982 Kantzer, C. Jack #11649
10/27/81
29-22-1, Tract 2 of Govt. Lot 6
End of Nelson Road, off Grapewiew Highway, 2 miles
from Allyn .
Office/Den Addition Contractor:
Jerry Wright
$10,920.00 Shoreline Exemption
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~ BUILDING PERMIT APPLICATION
MASON- COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 7 O I
DATE ISSUED
PERMIT NO. 116 / 9
NAME MAIL ADDRESS ZIP PHONE
OWNER _. clrY a STATE
DIRECTIONS
TO JOB SITE N
L 1 .q e- _ Y �� ,n LL
LEGAL
DESCR. fs Z (❑ SEE ATTACHED SHEET)
2` 1� Z G s _ . ,I-_ , _ _
CONTRACTOR NAME AIL ADDRESS CITY S STATE LICENSE NO. -14
PH NE
USE OF
BUILDING
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
J
0- L
y / t4r
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
c. o
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED 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 in 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 ❑
SEASONAL ❑ FLOODPLAIN
Firm ._�I#f: .L� T-" L )1-4 5';r—
E.D. NO. S.E.P.A. ❑
By �"" �— Special Approvals IN OUT YES APPROVED NO
Lic. No.J&L'? /(r 14 3 -�����`Ct .�ti Date %C -Z 7-zE'/ ZONING
PLANNING DEPT. �y
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
Owner APP ICATION ACCEPTED BY PLA CHECK BY APPROVED FOR ISSUANCE
Date. BY r
P CHECK VALIDATION CK. M.O. CASH P MIT VALIDATION CK. M.O. CASH
n
PLOT PLAN
ADDRESS M'r IZ412r, 1-4, PERMIT NO o 0
LEGAL ..S ��, �`!7 �z�r; �fi/� ,L L y ,�. ! �-..f %i:•r_ � o'�., L.� ;"'L, ��r.`�l//- �c_= a o
0
DESCRIPTION LOT BLK ADDITION N
u
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT r`
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.) Z
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 P"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.
Nj
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
TA
V
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
C '63t.� � 14
NAMES) OF OWNERl3) OF SITE 6 STRUCTUREW (PRINT) IGNATURE OF E O TH D REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE,
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTINQ