HomeMy WebLinkAboutBLD12483 Garage - BLD Permit / Conditions - 5/27/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 5 �- 1 y
DATE ISSUED
PERMIT NO.
OWNER L ADDRE 45 6 () ZIP Q J �61
DIRECTIONS
TO JOB SITE 2 M� �� OIJ IrI ��� �►�� D
LEGAL //' �` n r� I �^�- (❑ SEE ATTACHED SHEET)
DESCR. 1 �CJ vA� o Pro N �T � 1 T,ti-�l
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR (�
USE OF
BUILDING
Class of work: NEW El ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work CE Gt 'k-.p 6pep— PC40*1
S ZofYZq t
Valuation of work: $ 00cc PLAN CHECK FEE PERMIT FEES 5'Z?
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE y$t)
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. 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
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
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
c PERMANENT ❑ SHORELINES
conformance therewith.
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
Special Approvals IN OUT YES APPROVED NO
By
Lic. No. Date
ZONING
WING
EA
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. It2 Jt a t>
of the Mason County rdinance requirements for
which this p it is is d and that all work done will ROAD ACCESS
be . C f erewith. MOTOR VEHICLE PERMIT
LIGATION A PT D BY P NS CHECK BY APP VED FOR ISSUANCE
Owner Date B
L CHECK VALIDATION CK. M.O. CASH I
P MIT VALDATION CK. M.O. CASH
PLOT PLAN
/H
ADDRESS PERMIT NO. = v
Es € LA,1,4
LEGAL M fT Q1 6 c�1. NLvT� /c��BLK ��"�
DESCRIPTION ADDITION a
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
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 P"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'
Opp
Sj
I/We ce y that the proposed construction will conform to the dimernions and uses shown above and that no changes will be made without
first ob ining approval.
C
N AME(al OF OWNER(a) OF SITE III MIN-1 TUREI IPRIN T) 1GNAT E OF OWNER( ) OR TNORIZED R ENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
11IMELTON PRINTING
EXEMPTION'FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVFLOPMZNT PERMIT REQUIREMENT
TO:
The proposal b . to undertake
name of applicant/
the following development CC h s�ru 4,: a a r s e-
e aped is J
upon the following property
Ulagal description; i.e. , sec ion to thf
nearest quarter section
within U go q L/d 14 P. and/or its- associated
(name of water area
wetlands is exempt/not exempt from the requirement of a substantial
development permit because the development
4 - P
�4 d: 173-/ oqo
(identify exemptions as outlined in WAC - - 0
(Corps Public Notice Number if available)
The proposed development is consistent/inconsistent with:
CHECK ONE
CONSISTENT INCONSISTENT
Policies of the Shoreline Management
Act.
The master program.
Date i Signature of Authorized Local Govern-
ment Official)
ate 1�Eat ion
Zieman, Robert #12483
937-7077 5/27/82
Mading Sunny Shore, Addition 4, Tract 7
.5 mile south of Mason Lake Marina, East side of lake.
Garage 1 4 z 1 Contractor:
201x24' Self
$2,800.00 SHoreline Exemptinn
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