HomeMy WebLinkAboutBLD0326 Water Tank - BLD Application - 8/6/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
PERMIT NO.
ME � MAIL ADDRESS CITY&STATE r ZIP J PHONE
OWNER ))
LJ
DIRECTIONS
TO JOB SITE cj (� f� 1'
(❑ SEE ATTACHED SHEET)
LEGAL J
DESCR. / ��
MAIL ADDRESS CITY TE LICENSE NO. PHONE
CONTRACTOR NAME �� _-
USE OF (
BUILDING �`V -C P— U m �
Class of work: `><NEW ❑ ADDITION ❑ ALTERATI ❑ REPAIR El MOVE ❑ REMOVE
Describe work: �---•
Ile ' '
Valuation of rk: $ PLAN CHECK FEE PERMIT FEE ,5_L
AZ /),
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ 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
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
ordina ce requirements regulating the work for which
the p rmlt IS issued and all work done will be in PERMANENT ❑ SHORELINES ❑
conf mance therewith.
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
APPROVED
By Special Approvals IN OUT YES NO
ZONING
Lic. No. Date PLANNING DEPT.
EA � � -
HLTH 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. 5 `f
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANSPVECK BY APPROVED FOR ISSUANCE
Owner Date. �:
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING
PLOT PLAN
,AESS 61 F --
PERMIT NO. 0
�p2" e) I re G S S'S9 d OIF1 e r •eI G n >
LEGAL a 9
DESCRIPTION �� f LOT etJ�Z1 N Q� ,/� J�, gLK � � / DITION u
SITE AREA AZ O Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS /g/)e 1t`
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"ID 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'
0
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.
NAME(S) OF OWNER(S) OF SITE k STRUCTURE(S) (PR.IN T) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT-WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING
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