HomeMy WebLinkAboutBLD6568 Final Addition - BLD Permit / Conditions - 2/24/1981 U�, � �' B ILVI MIT APPLICATION
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MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 r
DATE ISSUED
PERMIT NO. ci
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER Ar�� - 1 w r�: �t;l� _ 7!Ich
DIRECTIONS v
TO .!OB SITE L) 6Ir ty U; no US
G Y (❑ SEE ATTAC Ep HEET)/ t f
1CR.j �R �/ U) A/
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE x
CONTRACTOR
USE OF
BUILDING Ll r ut,r
Class of work: O NEWQ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ d/ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS !DECKS CARPORT LL NOTICE
BATHROOMS__ (TOTAL SQ. FT. GARAGE
ATTACHED I I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT 1] OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED 1.1
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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 the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT-1 SHORELINES I
SEASONAL L! FLOODPLAIN i
Firm E.D. NO. S.E.P.A.
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
co tract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
ich this permit is issued and that all work done will ROAD ACCESS
e in conformance therewith. MOTOR VEHICLE P RMIT
r _� � � t'i APP TION A ED 8Y PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date,
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS
PLOT PLAN
ADDRESS PERMIT NO.
LEGAL s
DESCRIPTION LOT BLK ADDITION
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. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION P"ID 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. 1
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
JA
L
jz
0
1/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.
NAMES) OF OWNERS) OF SITE III STRUCTURES) (PRINT) SIGNATURE OF OWNER(S)IDR AUTHORIZED REPRESENTATIVE
DO NO WRITE WDOW THIS LINE
APPROVED
DISTRICT AS NOTED L DATE w
GHELTON PRINTING
Reid, Richard E. #6568
Hwy. 3 to 2nd Grapeview turnoff (just so. of Allyn)
Go 2 mi. down Grapeview Rd. (so.) , house is on left
Tr. 4 of NE SW 32-22-1
13 a 33 - a> I - 000
Addition Wood Stove
Contractor=
$4,350.00 Denis Shumaker
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