HomeMy WebLinkAboutBLD12389 Final Decks - BLD Permit / Conditions - 8/24/1982 b
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Smith, Wayne B.
426i 5761 #12389
5/10/'82
Lot 141 & 142, Division 4
Lake Limerick
Turn right t
g at fire station on Mason Lake
$d• onto
Dartmoor Drive for 1/2 mile
Decks , E 570
Dartmoor.
360 SQ•FT• Contractor;
None
$1,800.00
Shoreline Exemtpion
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+ BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 _
DATE ISSUED 1: — — F47
PERMIT NO. /.1 3 P9'
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTION
TO JOB SITE l ,qkI di ,
1
LEGAL 'P rT ^rt cc 1�')C rZ )_/2 ," (❑ SEE ATTACHED SHEET)
DESCR. L t-{ W&61"4 v 4— t 00 N«f+c:'le_
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work,
cY J
Valuation of work: $ /$r�v PLAN CHECK FEE PERMIT FEE�9
SPECIAL CONDITIO .
BEDROOMS iDECKS CARPORT 0 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 ❑
Firm SEASONAL ❑ FLOODPLAIN ❑
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
of the Mason County ordinance requirements for BUILDING DEPT. b /O to /8 4,114
which this permit is issued and that all work done will ROAD ACCESS
be in c nformance therewith. MOTOR VEHICLE PERMIT
ram— LIGATION AC EPTE BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. /G �_ / BY�v�
c f
PL CHECK VALIDATION CK,. M.O. CASH PERMIT VALIDATION M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. o
� o
= s
LEGAL
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 Pl"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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X FOR 1"=20'
J
1/We certify that the proposed construction will conform to the dimeraitlrq end uses Chown above and that no changes will be made without
first obtaining approval.
NAME(a) OF OWNER(e)OF SITE • STRUCTURE(a) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED ✓ - 412. DATE
GHELTON PRINTINO