HomeMy WebLinkAboutBLD11826 Final Log Piling - BLD Permit / Conditions - 12/8/1981 - - BUILDING PERA�IT APPLICATION
MASON COUNTY. //?A)
P.O.,Box 186 Shelton Washington 98584
426-5593
DATEISSUED
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. - PERMIT'NO.
OWNER NAME MAIL ADDRESS - _ CITY B STATE ZIP - PHONE
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DIRECTIONS . ... -
TOJOB'SITE i -
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LEGAL I I I 10 SEE ATTACHED HEED ,
NAME _ MAIL ADDRESS CITY 8 STATE LICENSE NO .PHONE
CONTRACTOR
USE OF ' .. ..+
BUILDING -
Class of work. ❑ NEW, ❑ ADDITION ❑ ALTERATION ,REPAIR El MOVE O',REMOVE
Describe work: : 1 _
' L .
a
Valuation of work`. $ / - PLAN CHECK FEE PERMIT FEE, '
SPECIAL CONDITIONS:
BEDROOMS IDECKS - ' CARPORT ❑ _ bTiCE .
BATHROOMS TOTAL,SO FT. GARAGE'❑
`ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBII G, HEATING; VENTILATING
NO. OF STORIES BASEMENT ❑ - OR AIR CONDITIONING - L. -
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑ -
'THIS PERMIT BECOMES NULL-AND VOID IF WORK ORCONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT -IZED IS NOTCOMMENCED WITHIN 180DAYS OR IF CONSTRUCTION OR WORK IS
D SUSPENDED OR ABANDONED FOR A PERIOD OF 180IDAVS AT ANYTIME AFTER
I certify that I am a currently registered contractof in WORK IS COMMENCED.
the State of Washington and I• am aware of, the
ordinance requirements regulating`the.work-for w h ich FOR OF-F�CE.�USE`--O N.��
thepermit Is issued ,and all work.done-Will be In -
conformance therewith. _ PERMANENT D', SHORELINES ❑ -- -
•' SEASONAL ❑ - - FLOODPLAN D, _
Firm E.D. NO -S.E.P.AI 0
By Special Approvals IN _'_ OUT YESAPPROVED NO
Llc No. _ Date
ZONING h ;
PLANNING DEPT.
` HEALTH DEPT.
OWNERS AFFIDAVIT .-.� ' � '
OVJ .. PUBLIC WORKS. . �.
I certify that I am exempt from the requirements ofthe ,FIRE MARSHAL '
contractor registration law-RCW 18.27, and am aware BUILDING DEPT
-
of the Mason ,:County ordinance requirements for, 07
' which this permit is issued and that all work done will.. - 'ROAD ACCESS:,,
be in conformance therewith.'' . MOTOR VEHICLE PERMIT
LICATIO A CPgTED BV ' PLANS CHECK BV APPROVED FOR ISSUANCE
Own ef r' Date /j2/1 P,� - BYO /
PL CHECK VALIDATION CK ' - M.O CASH V :PERMIT.VALIDATION CK.' .,M.O. CASH ' -
-': PLOT PLAN
ADDRESS ol ./d CH,;j12M1jjA1 `,.R nt PERMIT NO.LEGA
DESCRIPTIONG� �-HLOT ,� BLK ADDITION u
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"kRE
- FILED WITH:'PERMIT APPLICATION.,MACH BUILDING SITE MUST HAVE A SEPARATE PLOT. LAN.1. '
FOR NEW BUILDINGS'PROVIDE THE FOLLOWING 'INFORMATION,IN THE SPACE BELOW: LOCATION OF
PROPOSE D:CONSTRUCTION.AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND:SETB'ACK,DIMEN-
SIONS.SHOW EASEMENTS, FINISH:CONTOURS OR DRAINAGE, FIRST FLOORELEVATION,. STREET ELEVA-
TION 'A"iD.SEWER--SERVICE ELEVATION..SHOW LOCATION OF-'WATER,-SEWS R,`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', <
,
-
-I/We certify that the proposed construction will conform to the dimensions and ales shown above and that no chenpes will be made without
tint abtaininp approval.,- Zf
It
- R P SNTATIVE ..P IGN� RE'-0 . ERISIO UTNO ED E E
NAME ) OP,O.WN�1„OF IITE�e'ITRUC TUREI31 ( RINTI
DO NOT WRIPE BELOW THIS LINE
' APPROVES
DISTRICT - AS NOTED -
• EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT
TO: �. I�eLi h I /�l 9� G{1a um�,n 0410-
(name and addresjoi the appIica t)
The proposal by SQ WIP to undertake
(name of applicant /
the fol lowinq development C?OG � / bU I k P.!!(li
(be specific) /
won the folowing property T�ar� - UST Lot
( legal description; I .e., section to the
jao,✓ Ba In/
nearest quartee section)
within and/or its associated
(name of water a )
wetlands 'is exempt from thIrrequirement of a substantial ,developlent
permit because the development 3� #e) re t2aLr `)rA k ict
a
( identify exemptions as outli ed 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 ias
been finally approved or adopted by
the department.
The master program.
(date) (Sign re of Authorized LZa pvern-
ment Official )
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