HomeMy WebLinkAboutBLD9909 Cancelled Garage - BLD Permit / Conditions - 6/10/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 DATE ISSUED/6`/"9^V z
PERMIT NO.
NAME
MAIL ADDRESS CITY d STATE ZIP PHONE
kCONTRACTOR
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NAME MAIL ADDRESS LEGAL CITY&STATE LICENSE NO.
,1.USE OF 1
BUILDING (�-���
Class of work: [ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ / � y
PLAN CHEC F PERMIT FE S�q
SPECIAL CONDITIONS.
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(DECKS.__ _ _ CARPORTNOTICE
TOTAL SO. FT._ - GARAGE/I' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
BASEMENT ATTACHED OR AIR CONDITIONING.
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 ANYTIME AFTER
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am 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 PERMANENT I SHORELINES
conformance therewith.
SEASONAL FLOODPLAIN .
Firm E.D. NO. S.E.P.A. i
APPROVED
Special Approvals IN OUT YES NO
By
ZONING
Lic. No. Date
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT 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
which this permit is issued and that all work done will ROAD ACCESS
be i conformance t ith. MOTOR VEHICLE PERMIT
K _ VI/Dafe / / APPLI TION ACCEP D By PLANS CHECK BY APPR/Qy/,ED FOR ISSUAN
tl ! By
Owner � L� l
PL CHECK VALIDATION
M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS 41` % i j I-0 C SSC� f V'��7 PERMIT NO. _ a
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T1Z i 3 T77
S. A
LEGAL BLK ADDITION
DESCRIPTION LOT
7 1 Z`1 _
SITE AREA � �= Sa. 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 AAID 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.
OINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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I/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.
NAMalel OF OWN ERIaI OF aITE a 4: Ru TURE IaI IPRIN TI 1GNAT lr OF OWNER1a1 OR TNORIZED REP Ea ENTATIV E
DO NOT WRITE BELOW TNI INE
APPROVED DATE
DISTRICT AS NOTED
YMCLTON PRINTING
Johnson, Jack #9909
275-5400 6/10/82
Sam B. Thelers Home & Garden Tracts, Tract 36
NE 600 Roessel Road off Hwy 3, head west by elementary
school, last trailer on the right.
- Garage Contractor:
36'x36' None Listed
$11,664.00
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