HomeMy WebLinkAboutBLD7096 Carport - BLD Application - 8/13/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 (J � "-
426-5593
DATE ISSUED
PERMIT NO.
OWNER `N`AME MAIL ADDRESS CITY&STATE ZIP/ PHONE
DIRECTIONS
TO JOB SITE a ✓
LEGAL � � /� (❑ SEE ATTACHED SHEET)
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DESCR. (�� /C(/ -3 — 1
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR Kj
v1 r
USE OF /�
BUILDING l.,r
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Ow /'Z Y
Valuation of work: $ / d/ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS NOTICE
BATHROOMS TOTAL SO. FT. GAR ❑
ATTACHED [ I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE 11 DETACHED f
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 i
SEASONAL IJ FLOODPLAIN LI
Firm
E.D. NO. S.E.P.A. [_7
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 and that all work done will ROAD ACCESS
be ' ,conformance therewith. TOR VE qjgL.9 P RMIT
A ICATION AC P ED BY PLANS CHECK BY APPR E ISSUANCE
mer Date. B
�t
,N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS
a �
11 Aug. 80
0 WHOM IT P"AY CONCERN:
I own the property bordering the South and Fast sides of John
Main's property. I have no objection if he builds a car port
or other structure within five feet of the property line .
r anke
40
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PLOT PLAN IZ31 2Z '� zo
ADDRESS S�Dr r&42 71/1 ��Pryy 47idi1 waS 4 a3/0 PERMIT NO. (% / f 8
LEGAL
DESCRIPTION LOT BILK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS �b 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.
I
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
0 X Cc
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I/We certify that the proposed construction will conform to the dimensions and uses sho/o!wn awe aDAt at no changes will be made without
first obtaining approval. 25 21rc
A / �
NAM E(S') OF OWNER(S) OF SITE 6 STRUCTUREIS) (PRINT! IGNATURE OF OWN ER(S) AJ ORIZ D REPRESENTATIVE
DO OT WRITE BELOW THIS LI
APPROVED _
DISTRICT AS NOTED DATE
SHELTON P1'IIN TN3