HomeMy WebLinkAboutBLD9335 Foundation - BLD Permit / Conditions - 5/14/1976 Leitch, Michael #9335
5-14-76
Union, Block 51 , Lots 37-40 Contractor:
Leo Bell
Foundation
$1 ,000.00
CIS � s/��/�
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BUILDING PERMIT APPLICATION
MASON COUNTY
Q.Q. Box 186 Shelton, Washington 08584
DATE ISSUED i6
PERM IT NO. _ ! -�
OWNER NAME MAIL,(1DDRESS CITY&STATE ZIP PHONE
,
0,- Of. M
DIRECTIONS t /�
TO JOB SITE. (V 0 r o C 2 4 u __ _�-- G'V` Y/?�i •�Q O..i ,.,Y `f� 'C�.
LEGAL ( (U SEE ATTACHED SHEET)
DESCR. 3 7— T n J-/ lU i 0.,j S4
CONTRACTOR
NAME MAIL ADDRESS CITE 7�STATE LICENSE NO. PHONE
� �J
/ 2y � oN '✓�cKer r,a -Q�
�3 -oI-1216 3 —
USE OF
BUILDHVG
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION it REPAIR JQ MOVE EI REMOVE
Describe work: y-A
r _ /�
�C s-�. m..,st.••�..a. W� � U mot-
Valuation of work: $ 6 PLAN CHECK FEE PERMIT FEE o
�a. —
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPR VE-0 FOR ISSUANCE Typo of Occupancy Division
DY Cbnst. Group
Size of Bldg. No. of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVI i
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE f�-
the State of Washington and I am ev,are of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
cnn rmanc therewith. ZONING
HEALTH DEPT
=irm , PUBLIC WORKS
By—_-- _
ROAD DEFT.
Lic. No. 2`2 3 0!, I21 G `( Date `r L
OWNERS AFFIDAVIT
I certifv 11•at I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
whicl- this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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
Owner--. - ____.Date WORK IS COMMENCED.
PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION CK. M.O. CASH
1✓
i
PLOT PLAN
ADDRESS PERMIT NO. 9
LEGAL
DESCRIPTION LOT ) C r
BLK -fir ADDITION nv,` .✓
SITE AREA 0 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS � '=� 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'
S
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.
NAMES) OF OWNERS) OF SITE 6 STRUCTUREIS) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHEl-TON PRINT INS