HomeMy WebLinkAboutBLD9533 Demo - BLD Application - 2/11/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE ISSUED � �J7 _
PERMIT NO.
MAIL ADDRE55 / p i ZIP PHONE
OWNER r Q 4
DIRECTIONS ,� / —�---
TO JOB SITE Sh L�I�L_L_C1�_=.5��� a_-�l L.R R,, 1)
LEGAL MAIL ADDRESS ZIP S G. SHEET)
Vn (QOEE ATTACKED ENEETi
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MAfL ADDRE 5 P ONE
CONTRACTOR / '�"' �.� y JCj_ �- d
USE OF � MAIL A DRESS ��''""''�p NE LICENSE NO.
BUILDING h4o -J �4 '5:;- 'C
Class of work: %K EW ❑ADDITION VLTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
Describe work• — <
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.01
Valuation of work:$ �Q o-O PLAN CHECK FEE AV, a� PERMIT FEE �+.Q
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CH KED BY ]APPROVED FOR ISSUANCE BY
Type. Occupancy
� Const Group Division
'Size of Bldg. d�( p No.of Max.
(Total)Sq.Ft. Stories Occ.Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Requ
I Certify that 1 am a currently registered contractor in the State ZONINO
of Washington and the County of Mason and 1 am aware of the HEALTH OEPT.
ordinance requirements regulating the work for which the permit
Is Issued and all work done wiil be in conformance therewith. MOM DEPT.
Firm
By -
Lic. No. �` Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract
or registration law RCW 18.27, and am aware of the Mason
County ordinance requirements for which this permit is issued
and that all work done will be in conformance therewith. N 0 T I C E
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
(� HEATING. VENTILATING OR AIR CONDITIONING.
OW Dat "� � THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
SHELTON PRINTING CO.
PLOT PLAN
ADDRESS PERMIT NO.
a
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 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.
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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.
NAME(S) OF OWNER(S) OF SITE III STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING
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4k9533
Foley, T• F' h��
Lot 14 Plat of Longwood Beach 6-24-2
Boat house & Storage
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$6,500.00
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