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HomeMy WebLinkAboutBLD9966 Cabin - BLD Application - 8/19/1976 BUIL' ZoUNG PERM,IPPUCATIONT.�A MASON COUNTY P.O. Box 186 Shelton, Washington 98584 DATE ISSUED �/' / � PERMIT NO. OWNER NAME MAIL ADDRESS CITY STATE ZIP PHONE L.t ltJ LF W.� / DIRECTIONST ` TO JOB SITE LEGAL / — (❑ SEE ATTACHED SHEET) DESCR. /Z /--O T 96 /CiQKer ��5.�/.wil/V . CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. 27S_ Z�H�NE USE OF BUILDING Class of work: WINEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Valuation of work: $ _ PLAN CHECK FEE PERMIT FEE SPECIAL•CONDITIONS: t7 1 J 1 APPLICATION�CEPTED BY PLA S,CHECiC BY APPRO\'GD F R(�SUANCE� Type of Occupancy Division Const. � Group Size of Bldg. No. of Max. (Total) Sq. Ft. -'Ie6) Stories Occ. Load CONTRACTOR AFFIDAVf;' PERMANENT SEASONAL E.D.NUMBER I Certify that I am a currently registered contractor In RESIDENCE the State of Washington and I am aware of the MOBILE HOME ordinance requirements regulating the work for which the permit is issued and all work done will be in Special Approvals Required Received Not Required conformance therewith. ZONING HEALTH DEPT. Firm vp PUBLIC WORKS By ROAD DEPT. Lic. No��•/ E�--?_ 1'/✓lA Date co 9 _ 7� OWNERS AFFIDAVIT I certify that I am exempt from the requirements of the N O T I C E contract or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. which this permit is issued and that all work done will be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED 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 (Owner Date. WORK IS COMMENCED. I i."ECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS 7O7 S /g LQL/� T o) w4 211a f PERMIT NO. 0 o ,1r; pG /oo•-to y LEGAL I/OLvn�Eg OF ` ° DESCRIPTION LOT ! BLK / � � ) ADDITION Lf//Cw'� SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS / Sq. Ft. Ida© 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 AND 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. h �S- n INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' 11 I/We certify that th proposed construction will conform to the dimfnsicros and uses shown above and that no changes will be made without first obtaining approval. oz t4AM[(•) OR O NEf(S) OF a STRUCTUREISI (PRINT) IGNA 7UR E~OF OWNER(S) /UTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE