HomeMy WebLinkAboutBLD78-2546 FENCE - BLD Permit / Conditions - 7/3/1978 i
BUILDING PERMIT APPL CATION
MASON COUNT
P.O. Box 186 Shelton, Washington 98584
426-5593 7
DATE ISSUED
PERMIT NO.NAME �^ MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER "a/l!/TM E y l / G' /� d �S S' �G d J� `L'f� Y�' �i~�y
DIRECTIONS , n D fj,(/ft/j/�(J�1ldNdbe
TO JOB SITE rd ��J` ;%O/�l/v C� 0?il/ fT
I', / _ # ,'A /,� (❑ SEE ATTACHED SHEET)
LEGAL
DESCR. ,L 0 / �� �PGt d 1���/✓� ////�/✓O/P Ged
NAME
MAIL ADDRESS CITY&STAT LICENSE NO.
PHONE
CONTRACTOR + R d/1�
USE OF
BUILDING �v/✓
Class of work: VINEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ �y fry '7�/ PLAN CHECK FEE PERMIT FEE �p J#-V
SPECIAL CONDITIONS: d
BEDROOMS _ I DECKS _ CARPORT L] NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑ SEPARATE PERMS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED F1 OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE Ll DETACHED L
THIS PERMIT BEG IMES 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
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am aware of the FO OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in SHORELINES ❑
conformance therewith. PERMANENT
SEASONAL Ll FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. u i
Special Approvals IN OUT YES APPROVED NO
By
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 issued and that all work done will ROAD ACCESS
be in conformance they with. MOTOR VEHICLE: PERMIT
„j? _ LIGATION ACCE, IITED BY PLANS CHECK BY ROVED FOR ISSUANCE
r �
Ownq�r _ Date .
PLAN CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATIlityl
ON M.O. CASH
CK
•�. PLOT PLAN
ADDRESS / / '✓ ` X T-o^1 ERMIT NO.
LEGAL
DESCRIPTION LOT BLK DDITION Dy.1/�j✓D //� ���
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"=210' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HA A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN; HE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUI DING,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 EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE RAPH SQUARES ARE 5' C 5' OR 1"=20'
J
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I/We certify that the proposed construction will conform to the dimensions and uses show i above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE O NER(S) O AUTHORIZED R PRESENTATIVE
DO NOT WRITE BELOW THIS LINE',
APPROVED DATE
DISTRICT AS NOTED
SHELTON PRINTINS