HomeMy WebLinkAboutBLD8496 Boat Shelter - BLD Application - 9/16/1975 TG(Jc /> E3 v/'770 AJ
BUILDING PERMIT APPLICATION
MASON COUNTY
400 Shelton, Washington 98584 —
DATE ISSUED
PERMIT NO.
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OWNER (�(//'�t/ / S� 7
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DIRECTIONS I R � -{- / /
TO JOB SIMI 3 b 0 N 0 1, }ASV-;M 5 _ �G(, _ Ct 10! Wt 'Q S/ e alj 2 O �u//Od Pe✓
LEGAL '�'h a SQ /�9 O/ } d��oI'E PDOR ES S^ /�j�{ Q � �O (!—iSCC ATTACHED SHEET)
DESCR.�O E i f/t ✓ rE yy. 00 Q TW OdV���_C_1j.�LWJ� (/ a /1 C �/
1 MAIL ADDRESS PHONE
CONTRACTOR VQ— —
USE OF / AIL ADD R ESS PHONE LICENSE NO.
BUILDING
Class of work: D(NEW ❑ADDITION ❑ALTERATION Cl REPAIR ❑MOVE ❑ REMOVE
Describe work:
tT'
Valuation of work:$ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECKED BY APPgOVED fOp ISSUANCE BY.C3//�_l+.-C�� FConst.
Occupancy
I — Group Division
r� (�p No.of Max.
0 u Stories Occ.Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State
of Washington and the County of Mason and I am aware cf the HEALTH DEPT.
ordinance requirements regulating the wcrk Icr which the permit ORKB
is issued and all work done wi.1 be in conformance therewith. DitPT.
Firm
By
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract.
or registration law RCW 18.27, and am aware of the Mason N 0 T I C E
County ordinance requirements for which this permit is issued
and that all work done wil! be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
'fie C � Date 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
l
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
_ CLTON PRINTING CO.
PLOT PLAN �12 12 I�! 3 0
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ADDRESS fitzo D J [CO Ito PERMIT NO. O o a
S0, l 01` W 1W oieNF_ ot< Nwy E
LEGAL
DESCRIPTION U SL( LOTS ~� 0 ,`4l�t9CB1 / ADDITION : N
SITE AREA r Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 3 — Sq. Ft.
INSTRUCTIONS TO APPLICANT X.
O.
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN i"=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. �)
r� 0
I�
IV INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
C lye 4
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. / ( C' ' l-( r-
R om L lwee �
NAME(S) OF OWNER(5) OF SITE 6 STRUCTURE(5) IPRINT) IG ATU E OF OWNERS) R UTHORIZED REPRESENT TIVE
DO NOT WRITE BELOW THIS LINE
APPROVENOTED
�. /✓.0 C ��tl �� DATE DISTRICT AS NO
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