HomeMy WebLinkAboutBLD9611 Pole Bldg 26x30 - BLD Application - 11/19/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. 9611
OWNER ME MAIL A9DRESS C19&STATE ZIP p
DIRECTIONS
TO JOB SITE
LEGAL (❑SEE ATTACHED SHEET)'
DESCR.
CONTRACTOR177 � MAIL ADDRESS ITY TATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
G
Valuation of work: $ ,` pv PLAN CHECK FEE PERMIT FEE �
SPECIAL CONDITIONS: /J
BEDROOMS DECKS CARPORT❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FTj&0 FIREPLACE ❑ DETACHED ❑
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
conff II se therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. 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.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
b in conformance therewith. MOTOR VEHICLE PERMIT
P�g
ICATION/ACCEPTED BY PLANS CHECK BY APPROV FOR ISSU NCE-
0wne Date.�� eL BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
JRESs PERMIT NO. O o f o
LEGAL
DESCRIPTION LOT BLK ADDITION "
Q Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
SITE AREA
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 Al"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 INDICATE NORTH IN CIRCLE, ` GRAPH SQUARES ARE 5' X 5' OR 1"=20'
r
fU
FA
J
I/We certify that the proposed construction wil I s ar_UTft shown above and that no changes will be made without
first obtaining approval.
NAME(SI OF OWNER(31 OF SI�E . RUC TA E(31 IPRI T) tl_..ATURE OF OWN SI OR AUTHORIZED EPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6NELTON PRINT'NG