HomeMy WebLinkAboutBLD80-6597 ADD - BLD Permit / Conditions - 6/9/1980 Moreschi, James #6 97
6-9-8-0
Spring Road to Parkwood
Parkwood #25
Addition
Pl.teration
$11,600.00
t �r
_` �..
-�
;$1 ,,
P �*
�" ►a
'� ;�
n �
k
BUILDING PERMIT APPLICATION
MASON COUNTY,
P.O. Box 186 Shelton, Washing on 98584
426 5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STA ZIP PH NE
DIRECTIONS
TO JOB SITE
-k loam
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAM MAIL ADDRESS CITY&ST E LICENSE NO. PHONE
CONTRACTOR
USE OF ry�
BUILDING �� �.�� ��� S F'a C—er
Class of work: NEW ADDITION ALTERATION ❑ REPAIR ❑ M VE ❑ REMOVE
r t �
Describe work:
ia Eh,, OF )EXI'5TLjK:lIq' --jaEqqi--- . ei,.®SF_ ►J � i-�
,v m e P m L.. Zoom IETIATY Ropm I I fU
Valuation of work: $ PLAN CHECK FEE ��%' PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS !DECKS CARPORT)A 4100 NOTICE
BATHROOMS ITOTAL SQ. FT. GARAGE ❑
ATTACHED [I OR
PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT600 FIREPLACE ❑ DETACHED ❑
THIS PERMIT B OMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMM CED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OF 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
conformance therewith. PERMANENT [! SHORELINES ❑
SEASONAL [.1 FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. 1
By Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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. St0 �
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MO VEHIC ER IT
C Q/� AP LI ON ACC E Y PLANS CHECK BY APPROVED FOR ISSUANCE
Date. Q!/ BY
HECK VALIDATION CK. M.O. CASH 1PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. f v
n s
a c
LEGAL m
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 BUII 'DING,SITE,AND SETBACK DIMEN-
SIONS.SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST F OR ELEVATION, STREET ELEVA-
TION Al"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WAT SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE O EACH BUILDING AND MAJOR POR-
TION THEREOF. R
""- - INDICATE NORTH IN CIRCLE APH SQUARES ARE 5' X 5' OR 1"=20'
[ A�t
f
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
51 OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) 41. A UR OF WNER( IC' W.1T,&RI.E. REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
T AS NOTED (/ DATE
PRINTING