HomeMy WebLinkAboutBLD11941 Dormer - BLD Permit / Conditions - 1/20/1982 Nordstrom, Elmer #11941
(898-2555***) 1/20/82
Tract 17, except 17A, Sunny Beach Tracts(Katherine N.)
Near Alderbrook Inn
Alteration Contractor
D - A Construction
$5,000.00 Shoreline Exemption
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED__ 5ge XF0
PERMIT NO. - Z/9y�
OWNER NAME MAIL ADDRESS CITY 8 STATE JFAQ
PHONE
cfi r/� y ' 'DIRECTIONS
TO JOB SITEAi -- J I
LEGAL
DESCR. t ( SEE ATT H SHEET) f! /
coo—v --f
CONTRACTOR 1-7
NAME MAIL DRESS CITY 8 STATE LI ENSE NO. PHONE
77
USE OF
BUILDING
Class of work: O NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE U ,�
SPECIAL CONDITIONS:
BEDROOMS--.--- DECKS CARPORT
BATHROOMS____ TOTAL SO. FT.___ GARAGE NOTICE
NO. OF STORIES BASEMENT i ATTACHED _' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT.____ __ FIREPLACE i I DETACHED I:
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT ' ' SHORELINES
Firm
SEASONAL �; FLOODPLAIN
_ E'��-� � �:� 'T ' t
E.D. NO. S.E.P.A. f
By— Special Approvals IN OUT YES APPROVED NO
Lic. No. =L« /h D e ! C) ZONING
PLANNING DEPT. /
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the
contract or registration law RCW 18.27, and am aware FIRE MARSHAL
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith.
MOTOR VEHICLE PERMIT
Owner_ ICATION A
Date C PTED BY PLANS CHECK BY AP ROVED OR ISSUANC
&kd�Z
- ---- _
PLV CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION kCK.1 M.O. CASH
EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT
TO: 1=11l]ri ko f -
(name and address of the applicant)
The proposal by Srii11P. to undertake
(name of applicant
the f o I lowing development ('I T1'0 51 f ce
(be specific)
upon the folowing property �U 111)11 !>C_a ( b II e, rl� 11^ � f L'7
( legal de6cH ption?i-e., section to-'the
nearestlquarter section) '
within 0 � 6� r 11 ,, / and/or Its associated
(name of water aY ate-
wetlands is exempt from the requirement of a substantial development
permit because the development I S t'I1 e A 1 S�1 SdPer
0
(iden ify 'exemptions as outlined in WAC 173-14-040)
(Corps Public Notice Number if available)
The proposed development is consistent or inconsistent with:
CHECK ONE
CONSISTENT INCONSISTENT
Policies of the Shoreline Management
Act.
The guidelines of the Department of
Ecology where no master program has
been finally approved or adopted by '
the department.
The master program.
date) i (Signature of utho i'zed Local Govern-
ment Official ) /d