HomeMy WebLinkAboutBLD N/A - BLD Application - 8/4/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 Q
DATEISSUED v r y
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
o r o n 2 9L So
DIRECTIONS n_ } Cti'cs�) -f�d�o
TO JOB SITElh�pIOX. Q a $Sc2 vc / Q S S r a O.6V -9 w? k-5
LEGAL ^ (❑ SEE ATTACHED SHEET)
DESCR. ���'.�hh,�, �fj) �LJ / of IV'
NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
CONTRACTOR R, lO h �'.ZO erh 't L /V IF-21710
USE OF " /
BUILDING Rap ar*awnd Dr ck on Aciese
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Eck r rep/ 7%- r�
tyro
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS — CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED 'u SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE Ll DETACHED 1_1
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 SHORELINESX
SEASONAL ! 1 FLOODPLAIN i_j
Firm
E.D. NO. S.E.P.A. 1
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING-
PLANNING DEPT,
HEALTH DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE
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 RO SS
be in conformance therewith. MOTOR VEHICLE PERMIT
/) APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner, - .Date. 3
f
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
��ll
ADDRESS T 2V MPr'r'r�wozI. t ��, C/�?1CI�) PERMIT NO. f o
A >
a o
0
LEGAL
DESCRIPTION LOT BLK 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 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'
Ilk 1,
. �
r
y
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.
NAME(S) OF OWNER(S) OF SITE ! STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED �/ — y—�j
DISTRICT AS NOTED t �' DATE
6HELTON PRINTIN3