HomeMy WebLinkAboutBLD14635 Final Dining Room and Den - BLD Permit / Conditions - 10/18/1983 BUILDING PERMIT APPLICATION
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MASON COUNTY -�
P.O. Box 186 Shelton, Washington 98584
426-5593 Q_ ` —g
DATE ISSUED /Q`` ram
PERMIT NO. ` l �✓ �o5
OWNER NAME MAIL ADDRESS CITY STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE o 1190 V- d e ve
LEGAL n (❑ EE ATTACHED SHEET)�tkv I
ORIR NAME MA1QlkDDRESS CITY 6 STATE LICENSE NO. PHONE
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USE OF
BUILDING
Class of work: NEW ADDITION ALTERATION El REPAIR [I MOVE ❑ REMOVE
8"
Describe work: n f `
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Valuation of work: $ a PLAN CHECK FEE PERMIT FEE
I'A SC
SPECIAL CONDITIONS.
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BEDROOMS DEC ,� CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE El
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED 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 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 SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. 'TFDate 9 a3 ZONING
PLANN G DEPT. �j
OWNERS AFFIDAVIT HEAL PT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract Or gistration law RCW 18.27, and am aware BUILDING DE Q
of the ason County ordinance requirements for
which is permit is issued and that all work done will ROAD ACCESS
be i Conformance therewith. MOTOR VEHICLE PERMIT
LI ATI N AC E E Y PLANS C CK APPROVED FOR ISSUANCE
O ner Date . BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS G. w y1n PERMIT NO, f10
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LEGAL
DESCRIPTION LOT—"c BLK ADDITION T�_Q.(1
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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.
INDICATE NORTH IN CIRCLE 1 ! GRAPH SQUARES ARE 5' X 5' OR 1"=ZO'
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I/We certify that the proposed construction will conform to the dimansidm and uses shown above and that no changes will be made without
first obtaining approval.
NAMES) OF OWNER(!) OF SITE R STRUCTURE(!) (PRINT) IGNATURE OF OWNER(3pFR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE (y
APPROVED
DATE
DISTRICT AS NOTED
SHELTON PRINTING
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#14635
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McCLELLAN, Jeanette 9-9-83
Tract 1, Excluding South 50 feet, T18er Lake Tract
Go to Tiger Lake, stay
on main road until you see a
Brown Steel Building (unfinished)
Contractor
Ron Sampson 871-3176
Addition
Dinning room & Den
$11;480.00
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