HomeMy WebLinkAboutBLD13201 Bulkhead - BLD Permit / Conditions - 10/26/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. /t':u 0
PANAME? AIL ADDRESS CITY&STATE
ZIP PHONE
✓�' -ter,, a` a•-t 9o�,�iQe /rrc 96'y
�a .1 S/ �� ��)ih r Shy 1076
` (❑ SEE ATTACHED SHEET)
Y AMMAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
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/3cA� e y- j.;,Ds
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
/a /�
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT❑
BATHROOMS TOTAL SQ. FT._ GARAGE ❑ NOTICE
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
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 am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES
Firm—Va S C SEASONAL ❑
FLOODPLAIN ❑
j ? E.D. NO. S.E.P.A. ❑
By / Special Approvals IN OUT YES APPROVED NO
Lic. No. al Y e 5 1 c 4R Z Date Q G itE ZONING
PLA NING DEPT. TP
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the F
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEP of p 6 f a
6 Ott
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith.
MOTOR VEHICLE PERMIT
Owner Date. LICATIO� TED8Y CCg� PLANS CHECK BY APPROVED FOR ISSUANCE
(YY(( AD BY
PL ` CHECK VALIDATION CK. M.O. CASH PERMIT VALICIATIO-V M.O. CASH
PLOT PLAN
ADDRESS
J
�� ?��' �C''� PERMIT NO.
o c
= a
LEGAL "s 'o
DESCRIPTION LOT BLK 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 BUI LOING,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
TION THEREOF. POR-
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X FOR 1"=20'
e
JAF y
I/We certify that the proposed construction Will conform to the dimaniiNn and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE t STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
DISTRICT APPROVED
AS NOTED aG DATE
eHCLTON PRINTING
EXEMPTION ROM SHORELINE
MANAGEMENT ACT SURSTANTIAL
DRVFLOPMENT PERMIT REOUIREMENT
To: N - 3 tDGrk VIEW O(Z c f 7KO
Mh--
The prop6sal by
to undertake
name of applicant)
the following development ' i CPjCg 10tV CON-rt2O ` U
e sped is
upon the following (� V' �_ � AL�S
Pro rtQLA2 A
tlegal description; i.e, section to the
S SUV �/4 Z S -- Zo - Z
nearest quarter section
within1(�l: and/or its as
n6ie o water area)- associated
wetlands is x t/ ot--emempt from the requit-emnt of a substantial
de_�_o'e_t _Permit because the development IQ1v ��TQ
Wbkl
1-7 3 — .3
i enti y exempts s as out I fined in AC -
Corps u :c N t um r i avai a e
The proposed development i n ten
with: I"
CHECK ONE
CONSISTENT INCONSISTENT
Policies of the Shoreline Managemmt
Act.
The master program.
/X
Z� f
lat,!—
�Sijtnatur Authorized Local Govern-
ment Official)
2Co 1 qR
ate o xpirat on
Garzon, Jowden #13201
564-9076, Tocoma 10/26/82
Olympic View Lots 4 b 5
µycrs
Hartstene Island, E 249 11 Lane
Bulkhead (Erosion Control) Contractor:
4' high x 120' long Dave's Const.
$12,240.00 Shoreline Exemption
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