HomeMy WebLinkAboutBLD0190 Bulkhead Final - BD General - 1/29/1985 BUILDING PERMIT APPLICATIaN
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 /3
DATE ISSUED
PERMIT NO. OT/ 9 7
OWNER NAME MAIL ADDRESS CITY&STATE ZIP
S— ti S t� ct _ 1 e�i_c :1 9 �/
DIRECTIONS
TO JOB SITE 7 C ! �' S 1 t7 " _ - ���' 1 j c'�, CL CLS
fDESC:LR:[IW
G _ / (❑ EE ATTACHED SHEET)
(.� C� ,7 Z l7 C3 c:�L' . /- Z— r Z.X N It 2 LL)
NAME MAIL ADDRESS CITY&STATE n PHONE a
CONTRACTOR — I 1-4esN -^„ : �I-b1 ��, 4 S-` - c.li kc (L-- 5 fd
USE OF � t
BUILDING �� , �✓�� .. �� u: c_�� 4v S wcj/t J' ^'• �y c_ liv' E'-
Class of work: ❑ NEW ❑ ADDITION ALTERATION >(REPAIR ❑ MOVE ❑ REMOVE
Describe work:
f / / N_
n N � c�r E'� 0 d� � f�f fT Yr(' /`n v�o!. c; o,:C' /t' -
VV�.// �� l�L V 'I I•y`.- s... f V ."�.C. �i'rj,ct-�/ `! /r LL �S `^� �% �.'!C: LK Yl �.� 4i /�
i n H
Valuation of work: $ PLAN CHECK FEE PERMIT FEE s
✓, � 0 o ll�' yL/-
SPECIAL CONDITIONS:', �� �� L /(T eti GC1� �►'L�tXyf�d� { �1tJ
of )�
BEDROOMS_ I DECKS _ CARPORT F' NOTICE
BATHROOMS TOTAL SO. FT. _ GARAGE [
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [I ATTACHED i i OR AIR CONDITIONING.
TOTAL SC 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 U S ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT I SHORELINES I
(� �y SEASONAL a FLOODPLAIN f i
Fir e_ L �� 1 �s ncs
E.D. NO. S.E.P.A. I-
Special Approvals IN OUT YES APPROVED NO
_d
No. - 5tl '�Z C� Date 2� 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 BUILDING DEPT.
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
L���� APPLICATION ACCEPTED BY PLANS HECK BY APPROVED FOR ISSUANCE
Owner "� -. --.A —__ —Date , BY
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS I r ��/ PERMIT NO. : o
e
LEGAL �•'Z5 , C� �< 72-0 � O 10 Lug` r7 -`: 22-A) - l2 Z Le
DESCRIPTION LOT BLK ADDITION �.►
SITE AREA �"� �� Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS soo Sq.Ft.
INSTRUCTIONS TO APPLICANT s
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.) rb
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF e
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS,SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AkID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL ('1
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 V'X
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O
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1/We certi y that the roposed construction Will conform to the dimensicros and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE S STRUCTURE(S) (PRINT) SIGNATU O (S)F A THORI EO REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
DISTRICT AS NOTED APPROVED / P" �� DATE
SHELTON PRINTING
#0190
CARSTENSEN, Sid _ 7-3-84
W 50' of E 720' Gov Lot 2 17-22-2
4045 Palisades Place W.
Tacoma, Wash 98466
NE 7781 North Shore Rd . Contractor
Belfair, Wash Jesfield Const.
Retaining Wall
$3,442.00
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