HomeMy WebLinkAboutBLD4788 Woodshed and Storage - BLD Application - 5/29/1979 t Please make check
�ppason C u BUILDING PERMIT APPLICATION
Mason County
Treasurer. MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 79
PERMIT NO. �O
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
William J. Johnson Star Route 1, Box 217A Union, Wa. 98592
DIRECTIONS
TO JOB SITE
LEGAL _ (❑ SEE ATTACHED SHEET)
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
/bl J
USE OF
BUILDING Y
Class of work: ] NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Woodshed -;60--square feet @$6.00 per s.f.
4 0 D.
Valuation of work: $ �. PLAN CHECK FEE PERMIT FEE $24.00
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE
ATTACHED C1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
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 I 1
SEASONAL [ I FLOODPLAIN I I
Firm
E.D. NO. S.E.P.A. I 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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued?—,
hat all work done will ROAD ACCESS
be i conformance erewi MOTOR VEHICLE PERMIT
�� APPLICATION ACCEPTED BY PLANS CHECK BY A PROVED FO ISSUANCE
Own r —Date. fO
2 a,, "4Z, 4'
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH
I
1
PLOT PLAN 3 3Z
ADDRESS �~ , Z l / PERMIT NO. $ o
= o
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LEGAL
DESCRIPTIONS L '1 LOT BLK ADDITION u
SITE AREA Ze k r-' 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 FLOOD 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'
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I/We certify that the proposed construction will conform to the dimensions and uses shown abo a and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE d STRUCTURE(S) (PRINT) SIGNATURE OF O NER(S) R AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE 7_0
GHELT ON PRINTIN3