HomeMy WebLinkAboutBLD14847 Pier Rebuild - BLD Application - 10/21/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
y P.O. Box 186 Shelton, Washington 98584
426-5593 ��
DATEISSUED
10
PERMIT NO.
OWNER „' G�/V•(� i H I M{�L A2-2.sAl rya CITY 8 STATE
r�J Wa• ZI � PHONE O
DIRECTIONS �-TO JOB SITE W Se b GW /b6 V 4i/O N toll; '
LEGAL (❑ SEE ATTACHED S E
DESCR.
NAME MAI )r CITY _�^7 LIO�E NO PHONE
OR CONTRACT
USE OF �L •7
BUILDING f��oCr- r j,�'/L
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE REMOVE
Describe work:
Valuation of work: $ '_ ,. �yo PLAN CHEC FEE �� PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS _ CARPORT C; NOTICE
BATHROOMS TOTAL SO. FT. GARAGE [ )
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L: ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE I DETACHED
Ll
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME 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
SEASONAL i FLOODPLAIN i l
Firm E.D. NO. S.E.P.A. Il
By Special Approvals IN OUT YES APPROVED NO
Lic. No._ Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
I certify th exempt from the requirements of the FIRE MARSHAL
contrac r regis ation law RCW 18.27, and am aware BUILDING DEPT.
the Mason ounty o Hance requirements for
w I is permit Is Is
d and that all work done will ROAD ACCESS
be in o orma e t rewith. MOTOR VEHICLE PERMIT
O APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
y l
F 4
ADDRESS PERMIT NO. ` s o
a �
LEGAL
DESCRIPTION LOT BILK ADDITION u
SITE AREA 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 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.
AINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Ki
C c
c C
. f
7 7
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.
NAMEW OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) 1 A E OF OWNERS) O THORIZED REPRESENTATIVE
DO NOT WRITE BEL THIS LINE
APPROVE r f
DISTRICT AS NOTED (J �!, DATE C� lE
GHKLTON PRIN TNu