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HomeMy WebLinkAboutBLD11242 Final Foundation - BLD Permit / Conditions - 8/18/1981 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 � / DATE ISSUED PERMIT NO. OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE C- N� N SE // 34 EL?glt7 %'52S� �/?!o 10310 DIRECTIONS TO JOB SITE -Tb r- } ' ) LA)!� 1'EPS W OQ (.,-CST PT ;QC- LEGAL (❑ SEE ATTACHED SHEET) DESCR. 1_0T #A '�)k V)S�©�rJ � NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING vA©'1\A Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Pv �oe5`it t�� � �I S�� ►� s �C.�UfLt- Valuation of work: $ PLAN CHECK FEE PERMIT FEE tea. SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SQ. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ 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. 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 RCW 18.27, and am aware BUILDING DEPT. of the Mason County ordinance requirements for w h this permit is issued and that all work done will ROAD ACCESS in conform therewith. MOTOR VEHICLE PERMIT q /I Ur ry q / APPLI ATI N EPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Own Date. o 17 U� 6 BY PLAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION C M.O. CASH PLOT PLAN ADDRESS vG �y� PERMIT NO. LEGAL tPt V DESCRIPTIO LOT BLK ADDITION a SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS--!� 4 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 �+n.h 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. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' 1 3 x I/We certify that the proposed construction will conform to the dimension and asset shown above and that no changes will be made without first obtaining approval. NAME(S)OF OWNER(a) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRIT BE OW TMIS LINE APPROVE DATE DISTRICT AS NOTED 2 ONCLTON PRINTING JOHNMH, Eric P. #11242 SE 11 Foxglove, Shelton 08-18-81 To Fawn Lake, left on Crescent, on left at fork Lot 4, Div. 1, Fawn Lake Add Foundation Contractor - Self $1,001.00 oh ' 1 i