HomeMy WebLinkAboutBLD11727 Cancelled Shed - BLD Permit / Conditions - 11/17/1981 BUILDING PERMIT APPLICATION
MASON COUNTY ^
P.O. Box 186 Shelton, Washington 98584
426-5593
A D
PERMIT NO. 7
AM/E MAIL ADDRESS CITY fl STATE ZIP PHONE ` r
OWNER 4/a'C. / Ll[,lsc•.z �.C . '.X -
DIRECTIONS / /
TO JOB SITE L i, �'c ...
(.' SEE ATTACHED$H
LEGAL .�((rvt 7/� 1tt ''_' t"r r.i .. ( .;(.. /,f ( . .. .
DESCR. �ij f''> I -[;_.�ji -:�f^ ' LICENSE NO. PHONE
NAME % MAIL ADDRESS CITY 5 STATE
CONTRACTOR {..�
USE OF
BUILDING ^'
Class of work:' EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: R
2
Valuation of work: $ �a / PLAN CHECK FEE PERMIT F4E 33 `su
SPECIAL IONqf
BEDROOMS —__ IDECKS_.—.. -. _ CARPORT -- NOTICE
BATHROOMS TOTAL SO. FT.__- __ GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES __ BASEMENT ] ATTACHED OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE rI DETACHED I .
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
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 SHORELINES
conformance therewith. PERMANENT —
SEASONAL [ FLOODPLAIN I
Firm E.D. NO,_ S.E.P.A. I
Special Approvals IN OUT YES APPROVED 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 M
contract or registration law RCW 18.27, and am aware WILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in/conforma therewith. )MOTOR PERMIT` /� _ � VVEHICLE
CEPTER BV PLANS CHECK BY APPROVED
l VED FOR ISSUANCE
A Date
Owner A)
i
ERMIT VALIDATION CK. M.O. CASH
P AN CHECK' ALIDATION CK. M.O. CASH
PLOT PLAN
/�r',r llj I �7C-�Zt 1�L/ l[ �l �1 �•) PERMIT NO.
ADDRESS
�T;6 .' 7`_S /j s
r &
0
LEGAL BLK ADDITION S
DESCRIPTION LOT
SITE AREA-Sq. Ft. AREA Of SITE OCCUPIED BY BUILDINGS ._Sq.Ft. ,3
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 A-ID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GS AND ELECTRICAL
`\
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- 1
TION THEREOF. �I
i`
T
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
TT
I
J
J
I/We certify that the proposed construction will conform to the dimenei"and um shown above end that no changes will be made without
first obtaining approval.
N AME/al OF OWN ERIeI OF SITE
6 eTRUC TUREIeI IPR IN TI IGNATUR OF OWN ISI R AUTHORIZED REP ElENTATIVE
\DO NOT WRITE BELOW THIS LINE
DISTRICT AS NOTEAPPROVD ///� DATE
BHCLTON PRINTING
Johnson, Jack & Kathy #11727
(275-5400) 11/17/81
Sam Theler's Home & Garden Tracts 35, 36, 36A.
On Roessel Road, Approx 200 feet past clearing on right.
Storage Shed Contractor:
NOne
$2,400.00
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