HomeMy WebLinkAboutBLD10417 Trailer - BLD Permit / Conditions - 4/17/1981 10
BUILDING P RMff APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-55J3
DATE ISSUED �Trrr��
PERMIT NO. D � I
OWNER NAME- I MAIL ADDRESS CITY&STATE ZIP PHONE
GC
DIRECTIONS
TO JOB SITE 1 vo 1 3 to
LEGAL EE ATTACHED SHEET)
DESCR:
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING j t %:At
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR W MOVE ❑ REMOVE
Describe work:
O e 1 A&
Valuation of work: $ 'Of/ O d PLAN CHECK FEE PERMIT FEE a is
SPECIAL,CONDITIONS:
BEDROOMS DECKS CARPORT 0 NOTICE
BATHROOMS_ L 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 PER,WT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT RED IS NOTOOMM"CED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSP15NDE6 OFF AIIIIANOONED FOR A PERIOD OF 180 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,
V R, OFFICE .U;SE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
SEASONAL❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVE 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
contract or registration law ROW 18.27, and am aware BUILDING DEPT.
of the Mason County`ordinance .requirements for
which this permit Is Issued and that all work done will ROAD ACCESS
be Vconfrmance therewith MOTOR VEHICLE PERMIT
(CATION A EPT SY PLANS CHECK BY A OVED FO ISSUANCE
Owner Date. 7
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. ASH,
PLOT PLAN
ADDRESS 1r 9W 5 2 y PERMIT NO. G
N mi Nojj or. sco�S.�.1 4J� *IJwV� 5�►J '�� R".r- O14<
LEGAL
7 M
DESCRIPTION LOT BLK ADDITION P
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. AWN VALOMG SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE.SPACE BELOW: LOCATION OF �
PROPOSED CON111TRUCT"AND EXISTING IMPROVEMENTS.SHOW BUI LOING,SITE,AND SETBACK.DIMEN-
SIONS.SHOW EASEIIIENTS,,FINISH CONTOURS OR DRAI�N� AGE,'FIRST FLOOR ELEVATION, STREET ELEVA-
TION As'O-;,SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICELINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
i
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X W OR 1"-20
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I/We certify that the proposed constriction will aDnforrn to tM dimenatdne and tsoo shown above and that no changes will be mode without
first obtaining approval
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NAMlIa OWNlR(f OR SITS, ! STRUCTURE( ) ( RINT) U N, f).. 'R AU N 1 D REPRESENTATIVE
DO N T WRITE IS LINE
APPROVED
DISTRICT AS NOTED DATE
0141ILTON PRINTING
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