HomeMy WebLinkAboutBLD16175 Foundation - BLD Permit / Conditions - 9/26/1984 MUNSON, Richard #16175
9-26-84
Tract 13 34-22-3
807 Lake Street So. #302
Kirkland, Wash 98033 828-0754
1 mile past Alderbrook on water (next to big house with
tile roof)
Contractor
Olson Const.
Foundation ReplAcement
$1500.00 32z3q -3U
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r
Shorelines: r K
Setback:-, .�
Special Conditions:
Footing: 3- P"
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final:
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
DATA
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY 3 STATE ZIP PHONE
OWNER S. "bC og C7 y�
DIRECTIONS /lam �� `- ZSc , ' rro�
TO JOB SITE 6 �ji fj j-�
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. (' C 3 L /V W
M MAIL ADDRESS CI 3 T E LICENSE NO. PHONE
CONTRACTOR
GL Sr NC a?/STZ yZ! ib7
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
1
Valuation of work: $ �J v0 PLAN CHECK FEE PERMIT FEL,,, p d
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT Ll NOTICE
BATHROOMS I TOTAL SO. FT. GARAGE Li
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
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 FOR A PERIOD OF 180 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 i7
SEASONAL ❑ FLOODPLAIN 11
Firm L Q E.D. NO. S.E.P.A. Li
BY �'— Special Approvals IN OUT YES APPROVED NO
/1 /�
Lic. "� So �C�(""�Z 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
IC ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
-7 19
ADDRESS
PERMIT NO. f o
= o
n >
LEGAL
say-, l 3 S mac. t3 V 7` z,- A," /C'.3 kj
DESCRIPTION LOT BILK ADDITION u
SITE AREA—, Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 1Z 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
4
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 OWNER(S) OF SITE 65 TR CTURE(S) (PRINT) IGNATU E F OWNERS) OR A`—U THORIZEO REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
SHELTON PRINTING