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HomeMy WebLinkAboutBLD78-2358 POOL - BLD Permit / Conditions - 6/12/1978 Chapinski, A. D. #23586-12-78 Route 10, Box 668, Shelton Woodland Manor Lot 16 Swimming Pool $1,350.00 t , � �� ��j �� �; v � �.. BUILDING PERMIT APPLICATION MASON COUNT P.O. Box 186 Shelton, Washingt 98584 DATE ISSUED 7a PERMIT NO. OWNER NA MAIL ADDRES CITY&STATE ZIP PHONE DIRECTIONS p� 5' ) ScA O� i f s �1�`r TO JOB SITE I h ` LEGAL (❑ SEE ATTACHED HEET) DESCR. Z ® �' Qc) GC f l �Yla n o t f n CONTRACTOR NAMEr, l MAIL ADDRESS dITY&STA LICENSE NO. PHONE USE OF BUILDING Class of work: ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MO E ❑ REMOVE Describe work: , er it un e2 e 5 rn1-01000 ) Valuation of work: $ PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division y} ` Const. Group /77 I Size of Bldg. No. of Max. otal) Sq. Ft. Stories Occ. Load CONTRACTOR AFFIDAVIT PERMANENT SEASO AL 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 PUBLIC WORKS By ROAD DEPT. Lic. No. Date 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 SEPARATE PERMirs ARE REQUIRED FOR ELECTRI AL, PLUMBING, HEATING, of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING. which this permit is issued and that all work done will be in conformance therewith. THIS PERMIT BECC MES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED r IS NOT COMMENOED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS r� SUSPENDED OR A NDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER OWn -r �1 'kDate_ �D / .^ WORK IS COMME ED. PLAN CHECK VALIDATION CK. M.O. CASH tRMIT VALIDATION CK. M.O. ASH • a PLOT PLAN ADDRESS 0u le- l0 Q,-,e to 4, RMIT NO. CU©o al/'g d LEGAL DESCRIPTION LOT Cl BLK ADDITION i Sq.Ft. SITE AREA -'' `�>,1 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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: LOCATI N OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST F OR ELEVATION, STREET LEVA- TION A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE CF EACH BUILDING AND MAJOR POR- TION THEREOF. INDICATE NORTH IN CIRCLE h ��� 15 13 RAPH SQUARES ARE 5' X 5' OR 1"=20' T� N I � o i I/We certify that the proposed construction will conf to the diNensions and uses sho above and that no changes will be made without first obtaining approval. NAME(S) OF OWNER(S) OF SITE & STRUCTUREM (PRINT) �. ' O,`/JN E. IS) OR THORIZED EPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DATE DISTRICT AS NOTED GHELTON PRINTIN3