HomeMy WebLinkAboutBLD11193 Roofing - BLD Application - 8/11/1981 3
BUILDING ,PER
MIT APPLICATION ' .
' MASON COUNTY
P_O. Box 1W Shelton, Washington 98584
426-5593
G
p DATE 0 .
ISSUED
3 a � -
_ _ PERMIT NO. �3
rN4AME
NAME �' MAIL ADDRESS ',CITY&STATE ZIP PHONE
c 0 yy1 rY71 ILis . F*I-r- �y�y,, �j (0 SEE ATTACHED 6HEET)
�CHc'T 1'7 �2 ipfk 18 132QoK , P • /RJ�G `� .` NAME - MAIL ADDRESS, ' .CITY&'STATE LICENSE NO ' PHONE
�.::p K ,� 7�6-C1wUSE OF
�rT�NdTZ'7�- _ .a'
Class of work: ' 'NEW ❑ 'ADDITION El ALTERATION ❑ REPAIR ❑MOVE [],REMOVE - -
Describe work:
Lome.
a3.�-
Valuation of work:$ . PLAN CHECK FEE PE. MIT FEE•
,
SPECIAL:CONDITIONS: '.. rJR. j, 2/ Lifrl/
BEDROOMS DECKS CARPORT. - goo NOTICE -
BATHROOMS TOTAL SO FT. GARAGE
ATTACHED El . SEPARATE PERMITS ARE REQUIRED_ FOR PLUMB NG HEATING, VENTILATING
NO. OF STORIES_ BASEMENT'❑ - -,OR AIR CONDITIONING
TOTAL.SO.•FT: FIREPLACE ❑ DETACHED ❑,,. - IR
IZED IS NOT COMMENCED WITHIN-180 DAYS,OR IFC CONSTRUCTIONWORKI-
_ THIS PERMIT BECOMES NULL AND VOID IF WORK O
CONTRACTOR AFFIDAVIT CONSTRUCTION ANY OR WORKAFTER
SUSPENDED OR ABANDONED FORA PERIOD OF,IBQDAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor,in, WORK IS COMM ENCED. c w'the State of Washington and I am aware of the FOR Q`FFICELUS - ONLY
ordinance requirements"regulating the work for which - ""' '
"thee permit is� issued,and all ..work done well be in
conformance therewith - PERMANEN - SHORELINE -
� SEASONAL❑: FLOODPLA14 ❑
Firm,. �"✓Gt/ f)1)Jef% /1l f j. (��L7 + E.D. NO.. ` ' S.E.P.A C
By .Special:Approvals IN OUT YES APPROVED NO
Lic. No.`&A -,M,:;4 Date ZONING,
PLANNING'DEPT.
HEALTH DEPT. - +
OWNERS AFFIDAVIT -
.. PUBLIC WORKS
I certify that Iam exempt from the requirements of the AFIRE MARSHAL ;' -
contract or registration law RCW 18.27 and am aware ^` BUILDING DEPT.
of the Mason County ordinance requirements for, - -
whl .this permit is issued and that all work done will ROADACCESS'•
b ` i._conformance'th &with. , R VEHICLE PERMIT,
/ PP. A O CCEPT DBV .PLANS CHECK BY " APPROVEDfOR I$SUANCF,
-.Owne Data
PERMIT VALIDATION CK. MtO. CASH+
PLAN CHECK VALIDATION CK. M.O. CASH - - /
PLOT,.PLAN
ADDRESS F .'. / /. r �I�IID PERMITNO.
LEGAL- „iRAT
"DESCRIPTION Jor BLK ' ADDITION`
SITE AREA Sq,it. AREA OF SITE OCCUPIED BY BUILDINGS �3 Sq.,Ft. '
INSTRUCTIONS TO APPLICANT
THIS FORM-NEED.NOT BE USED W HEN,PLO T-PLANS DRAWN TO SCALE OF,NOT LESS THAN 1'r-20' IkRE
'-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 OR
.PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK'DI EN "
'SIONS.SHOW,EASEMENTS,FIN ISH�CONTOURS`OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELI VA ,'
TION A&'D`SEWER SERVICE-EL'EVATION.F SHOW LOCATION'OF'WATER, SEWER, GAS AND, LECTRICAL
SERVICE LINES.SHOW:LOCATIOKOF SURVEY PINS.SPIT IFYTHE USE OF EACH BUILDING AND MAJOR�OR- "
TION THEREOF."'
_ y, ,
l w
INDICATE NORTHIN CIRCLE GRAPH SQUARES ARE 5' X I' OR 1 '=20'`-
1111YYYY r
Ao
pi Ua.
,
II
C'.
I/Wa wrtify that
,the Proposed comtruction,will cobform'to the tlimamlonarand uses shown above and that no'chanpes will be mode without-'
. . .'first obtaining aPProvaL
r ,
NAMED) OF.OWNERM OF SITE.a STN TURF(S) (PRINT) IGNATURE OF OWNERIS) OR AU THOR/ZED.MEPAESENTATIVE
DO NOT WRITE BELOW THIS LINE' '
r APPROVED
DISTRICT 'AS NOTED DATE:
_ J 17
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