HomeMy WebLinkAboutBLD11821 Deck - BLD Permit / Conditions - 12/7/1981 BUILDING PERMIT APPLICATION CLA-
MASON:COUNTY
P.O. Box 186 Shelton,Washington 98584
426-5593
DATE ISSUED (�
. . PERMIT NO.
OWNER NAME MAIL ADDBF+$�. - .., CITY TATE ZIP `-P O
A.tG-5
DIRECTIONS _ - .;
TO JOB SITE �.� cG..; a 3..0_ tBretoP r -, . 3 r01 ck '+ J r 1 ye
LEGAL _ - _ f IO SEE ATTACHED SHET)-
DESCR.
NAME ` MAIL ADDRESS - 4. CITY 8 STATE .LICENSE NO - PHONE
CONTRACTOR - SC_�� -
USE-OF
BUILDING - -
Class of Work: NEW ❑ADDITION, ❑'A/LT-ER``ATION ❑ REPAIR // ❑ MOVE O REMOVE
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Describe wo{ 11 d Q CK CP lD E�i+V.
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Valuation of work: $ PLAN CHECK,FEE y ' PERMIT F
SPECIAL CONDITIONS`
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SO FT. GARAGE El
ATTACHED ❑ SEPARATE'PERMITS ARE REOUIRED,FORi PLUMBING, HEATING,'VENTILATING
NO: OF STORIES_ BASEMENT ❑ OR AIR CONDITIONING
TOTAL 50. .FT. FIREPLACE-0 DETACHED ❑ - -
- THIS PERMIT BECOMES NULL AND VOID IF YVORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITH IN 180 DAYS,ORIFC NSTR_UCTION ORWORKIS =
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 AYSAT ANYTIME AFTER
I certify that I am acurrently registered contractor in WORK IS COMMENCED.' '
the State of Washington and;.I, amp aware- of the - o w' `
ordinance requirements regulating the work:for which FO-fl. OFFICE S4 . G :O�LY
the permit Is issued and .all work done will be In - -
conformance therewith'', - PERMANENT ❑ - SHORELINES ❑
'SEASONAL ❑ FLOODPLAIN ❑
Firm
- E.D: NO. S.E.P.A� ❑ "
By Special Approvals ' IN OUT YES APPROVED NO
Lic No. - `Date - ZONING -
PLANNING DEPT.
OWNERS AFFIDAVIT- ' HEALTH DEPT.'
PUBLIC_WORKS -
I certify that I am exempt from the,requirements of the- FIRE M
contract or.registration law RCW 18 27, and an, aware BUILDING-.DE /Z 7 /
of the Mason County ordinance .requirements .for.
which this permit is issued and that all work done will ROAD ACCESS _
therewith., MOTOR VEHICLE PERMIT '
?RCHECK
con'forman tIi '
/ R PLICATION AC{.�ccG,,EEEPTED BY PLANS CHECK BY -AP VIED FOR ISSUANCE
f Date LZ - "'
VALIDATION ' CK. 'M O. •CASH - PERMIT VALIDATION CK. M.O., ' . CASH
PLOT PLAN
ADDRESS ' S. U (l,(,�)Qiy PERMIT NO. o
! P
C INLEGAL
DESCRIPTION `: LOT SLK ADDITION-
SITE
AREA Sq.Ft. -_'' AREA OR SITE OCCUPIED BYBUILDINGS - Sq._Ft. �
INSTRUCTIONS TO"APPLICANT
THIS FORM NEED NOT,.,BE USED-WHENPLOT PLANS DRAWN TO SCALE OF NOT LESS THAN,1"=20'. ARE. . „
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT'PLANJ
FOR NEW BUILDINGS:PROVIDE THE FOLLOWING INFORMATION IN.THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND,SETBACK DI EN-
SIONS SHOW EASEMENTS, FINISH.CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET EL VA- ,
TION P•ID SEWER SERVICE 'ELEVATION. SHOW LOCATION OF'WATER,'SEWER, GAS':AND ELECTRICAL. " r
SERVICE LINES:SHOW'LOCATION OF SURVEY PINS.SPECIFV'THE USE OF EACH'BUILDING-AND MAJOR POR-
'TIONiTHEREOF. :;,. ,.•'
VINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X S' OR 1"=20'Samms
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3
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^ -.I/We certify that the proposed construction will Conform Jolt 1 he
o the dimensions;and,uses shown above and that no changes will be made without '
first obtaining approver. -' ..
NAMEISI-0F OWN-PER( OF SITE 6 STRUCTURE(SI (P.RINTI IGN TORE OF OW NERISI,ORAUTHORIZED REP lEN TA TIVE
""DO NOT.WR/T .BELOW TN/S LINE
DISTRIC
t,/
"T AS NOTED ��::%,�. "�� DATE.
S.6 TON PRINTING - : • '
i
Oblizalo, James #11821
(426-6922) 12/7/81
8-19-3, SW 1/4, NE 1/4, SW. 1/4
S. E. '530 .Brewer%Road, 3rd dirt driveway to right off j
Brewer, 3100 Olympia Highway North, Shi;�l.ton.
Deck Contractor. I
Self
94,400.00
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