HomeMy WebLinkAboutBLD2282 Move Home - BLD Application - 7/9/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 Q
DATE ISSUED ��'y►7/
PERMIT NO. ��a
OWNER NAME MAIL DRESS & A E ZIP PHONE
ir) L !j
DIRECTIONS ` 4 4/-K-� E 7
TO JOB SITE /
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. �14.
NAME MAI ADD SS �ITY&STATE LICENSE NO. PHONE
CONTRACTOR7<
T 6z / ( �!
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR IEVVIOVE ❑ REMOVE
Describe work:
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Valuation of work: $ a7,O0O PLAN CHECK FEE PERMI FEE //U ' 00
SPECIAL CONDITIONS:
BEDROOMS DECKS _ CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SQ. FT. GARAGE ❑
ATTACHED I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ,_ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE �_ DETACHED [I
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
Conformance therewith. PERMANENT SHORELINES ❑
SEASONAL [] FLOODPLAIN ❑
Firm
E.D. NO._ _ S.E.P.A.
By Special Approvals IN OUT
YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. 60
PUBLIC WORKS
certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformancetherewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPRO�UANCE
G'
Ow7 Date. ,� Y
PLAN CHECK VALIDATION CKt PERMIT VALIDATION CK. M.O. ASH
s- PLOT PLAN
ADDRESS [�� �� i PERMIT NO.
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LEGAL
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DESCRIPTION �_�e-� �y "LOT L✓✓7�T,K.�6 L Z BLK ` � /) ADDITION u
SITE AREA '"Glt' 'f Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS i 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 A"'D 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'
L �
UT
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.
NA E(S) OFOWNER(S) OF SITE ! STRUCTURE(S) (PRINT) IGNATUR OF ERIS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS L/N
APPROVED �(//� �J
DISTRICT AS NOTED PLC �K G DATE ��/Zr2