HomeMy WebLinkAboutBLD138 Addition - BLD Permit / Conditions - 8/10/1979 Cannon, Charlie #138
8-10-79
33-20-3 Tr. 4 NW SW
Out cole road one mile
Route 3, Box 794, Shelton
Addition
$6,600.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �—�C 79
PERMIT NO.
NA MAIL DRESS CITY T ZIP PHONE
4DIRECTIONS
/ 3 L <L Z( -lJ
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TE . ,��s�
�. f (❑ SEE ATTACHED SHEET)
"T�— ^yam ,
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING �fC v
Class of work: ❑ NEW XADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ' +
Valuation of work: $ �:/ � /��� a LAN CHECK FEE PERMIT F
SPECIAL CONDITIONS: �' �►`
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
yy
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ElATTACHED X OR AIR CONDITIONING.
TOTAL SO. FT G Z> FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 1-1
conformance therewith.
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
B Special Approvals IN OUT YES APPROVED NO
Y
Lic. 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
which this permit is i ed and that all work done will ROAD ACCESS
be in conforWnc ther ith. MOTOR VEHICLE PERMIT
XICATION A CEPTE BY PLANS CHECK BY APPROVED FOR ISSUANCE
Own ate_
BY
r.Q U
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
•
ADDRESS PERMIT NO. f °v
n >
a c
a
n
LEGAL
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 BUILDING,SITE,AND SETBACK DIMEN-
SIONS.SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AkID 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
0
5
f
F
1/We certify that the proposed construction will conform to the dimensidns and uses shown above and that no changes will be made without
first obtaining approval.
LIt LAMSI OF OWN ER(S) OF SITE R STRUCTUREM (PRINT) SIGNATURE OF OWNER(5) OR AU TMORIZ D R EN TA T I V E
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
SHELTON PnTNTING