HomeMy WebLinkAboutBLD7991 Wrecking Yard - BLD Application - 1/19/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAM A ADDRESS ITY& TATE ZIP PHONE
DIRECTIONS
TO JOB SITE nwto
LEGAL L
DESCR. ��� /_ 1� (❑ SEE ATTACHED SHEET)
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CONTRACTOR NAM MAIL ADDRESS CITY&STATE L NSE O. PHONE
USE OF
BUILDING s'�O e_
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
Valuation of work: $ _ PLAN CHECK FEE ,/ PERMIT FEE
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SPECIAL CONDITIONS: C
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BEDROOMS DECKS CARPORT ElNOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I_i ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE L DETACHED U
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 am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
Firm SEASONALii FLOODPLAIN ; '.
E.D. NO. S.E.P.A. i
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
\ APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Own Date .
BY
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LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS � e jE tv PERMIT NO. o 0
LEGAL w(2) k4 C/C//lI ,7J�W brV� r1 ICI 9
DESCRIPTION LOT BILK ADDITIONN
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS. Sq. Ft. v
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.
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INDICATE NORTH IN CIRCLE�_/,6 GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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 withoU
firs obtaining approval. /_�,Gc `
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 D E
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