HomeMy WebLinkAboutBLD14640 Retaining Wall - BLD Permit / Conditions - 9/15/1983 aWELi, �.a�ert 14640
9-15-83
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Madding Sunny Slope, Division 4, Tract 9
2 mile south of the Mason Lake Marina, 1441 Mason
Lake Drive West
Contractor i
Dennyts Home Improvements
Roger Denny 426-3767
Retaining Wall
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B lilL D ING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 --
DATEISSUED
PERMIT NO. , � -`•�CI� —
OWNER NAME MAIL ADDRESS CITY R STATE ZIP PHONE
DIRECTIONS
TO JOB SITE ( M1 Lf- LA l =C MAJhAjA
LEGAL (❑SEE ATTACHED SHEET)
DESCR. .fX"1,Nt, S ry 5 e
CONTRACTOR
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
&j j-1 i`1CLI G Z-f. 7L�
b6u�V`S�-1 - tln� FA;�( a4 3 'MAS . e. t �IJ IZ , t
USE Of
BUILDING
Class of work: KNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
kEMAA)(A)L WAALZ r t L PN Z(
i 2qo
Valuation of work: $ "Z - - Z PERMIT FEE
a
SPECIAL CONDITIONS:
i
7
f
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. 'FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
! THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR'WORK IS
i
SUSPENDED OR'ABANDONED"FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
1
+ I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR O r r^^I w` O-■ry■
L
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
b Firm emtqyl vicjh
! E.D. NO. S.E.P.A. ❑
By �y ( t�e� .--� Special Approvals IN OUT YES APPROVED NO
Llc. No. Date
ZONING
PLANNING DEPT.
` HEALTH DEPT.'
OWNERS AFFIDAVIT
PUBLIC,WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
I which this permit is issued and'that all work done will ROAbl ACCESS
be in nformance therewith. MOTOR VEHICLE PERMIT
A PLICATI0 ACCE E Y PLANS CHECK BY APPROVED FOR ISSUANCE
O ner' Date.
i
I
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
C., RR
ADDRESS bOW C (a PERMIT NO. ° g
J
IYIRD�ti� �U �YS(4 �cA�' ( o
LEGAL �
DESCRIPTION LOT BLK ADDITION
w
u
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Fr.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT,PLANS DRAWN TO SCALE OF NOT LESS THAN t"=20' ARE
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 A-ID 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' OR 1"=20'
I/We certify that the proposed construction will conform to the dimes ions and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) O'F.OWNERM OF SITE-k STRUCTURE(S) '.(PRINT) IGNA URE OF..OWNERr(S) OIVUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE '
SHELTON PRINTING