HomeMy WebLinkAboutBLD11870 Concrete Slab - BLD Application - 12/21/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 as l /ej
DATE ISSUED
PERMIT NO. 1�7�
NAME MAIL ADDRESS CITY 8 STATE ZIP I PHONE
.OWNER �
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DIRECTIONS
TO JOB SITE o D Al
LEGAL _J /. 'L ,,/ v ,,/ (❑ SEE ATTACHEDT T)
DESCR.
YLI
DE CR
NAME MAIL ADDRESS CITY STATE LICENSE NO PHONE
CONTRACTOR ,
USE OF
BUILDING N�/ �l. KA/'
Class of work: J$ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
,SLA C tf L. •�O
Valuation of work: $ PLAN CHECK FEE PE i MIT FEE
'
SPECIAL CONDITIONS: '
BEDROOMS (DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO, OF STORIES_ BASEMENT O ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT (ZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 18 i 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 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 O FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
iBUILDING
vals !L1
YES APPROVED NO
By
Lic. No. Date
DEPT.
PT.
OWNERS AFFIDAVIT RKS
I certify that I am exempt from the requirements of the HAL
contract or registration law RCW 18.27, and am aware 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
R (CATION AC PTED BY PLANS CHECK BV APPROVED FOR ISSUANCE
Owner Date . B `
M.O. ASH
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK'.
f P
PLOT PLAN
ADDRESS 9 9'D ar'.�ri f /s/_ PERMIT NO.
w s
a o
P
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA-Sq.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 I
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 ARID 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' 0 1"=20'
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I/We certify that the proposed construction will Conform to tha dimaralons and Uses shown above and that no changes will be made without
first obtaining approval.
NAMEM OF OWNER(!) OF SITE a STRUCTURE(S) (PRINT) IGNATUR OF OWNER($) OR AUTHORIZED REP Ea ENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED 0007r f�{ DATE
GHCLTON PRINTING
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#11870
Brent, Glen 12-21-81
14-20-2 W 1/2 NW 1/4 NE 1/4 Sly of R/W ,,,,,, @�
E 2990 South Island Road, Shelton jttll�ts
Shop & Garage
$10,800.00
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