HomeMy WebLinkAboutBLD9480 Addition - BLD Permit / Conditions - 10/23/1979 Ellingsen, Raymond D. #9480
10-23-79
Tract 33 Pebble Beach Park 6a.►, 25do X
42 miles past Union, Washington
Addition to residence
$3,264.00
elf- d9PI11-,Z8'-79
re BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 Dd23 7
DATE ISSUED
PERMIT NO. q-4 90
OWNER NAME MAIL ADDRESS CITY&S E ZIP PHONE
DIRECTIONS �j
TO JOB SITE
LEGAL 1 / (❑ SEE ATTACHED SHEET)
DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW EKADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
. dO
Valuation of work: $ PLAN CHECK FEE P MIT FEED
14,
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT [) NOTICE
BATHROOMS TOTAL SO. FT. GARAGE L]
ATTACHED LI SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT.�� FIREPLACE [] DETACHED [J
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 LI SHORELINES ,_1
SEASONAL [1 FLOODPLAIN I 1
Firm
E.D. NO. S.E.P.A. Cl
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. O/9
of the Mason County ordinance requirements for
which this permit ' issued and that all work done will ROAD ACCESS
i I conforman h. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. coy B .�
i
PLAN HECK VALIDATION CK. M.O. CAS PERMIT VALIDATION CK. M.O. CASH
v
PLOT PLAN
ADDRESS / �7 rf '.,-�/ PERMIT NO. F o
0
n >
a o
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 Al"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL r\
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY TH ,USE EAC BUILDING AN AJOR POR-
TION THEREOF. r�
INDICATE NORTH IN CIRCLE GF14PH SQUARES ARE 5' X 5' 0 1"= '
G`c•
c-
t� I
D
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.
X'AY1-110V,D P FRIA16sCH Zvtdj r Adl-4�el
NAME(S) OF OWNERS) OF SITE ! STRUCTUREW (PRINT) SIGNATUR F OWNER(5) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THISIiJINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTINS