HomeMy WebLinkAboutBLD3001 Tool Shed - BLD Application - 9/5/1978 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 4 , 7,f
DATE ISSUED
QZ / PERMIT NO. BOO /
OWNER NAME ¢ 3 L . I F(R MAIL ADDRESS
Z PHONE
10 PRN�{61��oDITMI./tN�E Sly-T&jq WA- `�5�5��' Z6-,q.0 b�'
DIRECTIONS •�Gl�
TO JOB SITE t _ N1�LL� N, Of 1+1G11 'SC*O� {�1 SPA114"00.D f PI'MN OFF SpR�o D
LEGAL (O SEE ATTACHED SHEET)
DESCR. Lorr IO SPa Q6-Woop, A-W ►1oW 5 4E---r-w W R
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING 'TOOL � 17 ,�! X 1�.,t 000D FRAMIE
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: bE)L 64E-D 101 Wi DE )( 1 Z' l-09& X �,� �h"*
WOOD V: fA A-M S &1°rM BR a� B AU =P� Rao
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
v 7�4 : o-c)
SPECIAL CONDITIONS:
BEDROOMS JYJA DECKS 1141A CARPORT ❑ NOTICE
BATHROOMS WPV TOTAL SO. FT. M h GARAGE ❑
NO. OF STORIES I BASEMENT ElATTACHED ❑ t4)h SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. FT. 7-0 FIREPLACE ❑ DETACHED ❑ L
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 Li
SEASONAL ❑ FLOODPLAIN iJ
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.
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
be in conformance therewith. MOTOR VEHICLE PERMIT
✓ ��� Gi �� APPLICATION ACCEPTED BY PLANS CHECK BY AP ROVED FOR ISSUANCE
Owner Date .
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
t� PLOT PLAN �(zo1Z CJC�JI V
y �li `)�I�IN�WCG71�{C LI(`,� 1-/rt MIT .
ADDRESSLEGAL
Yv .70 PER NO
DESCRIPTION LOT 10 BLK ADDITION 5 1 R% N 6- WOOD
Yf Red:
SITE AREA 1-)CoC Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 20 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
'F R ct ctt
A-
L T t
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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.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PRINT,N