HomeMy WebLinkAboutBLD9352 Wood Frame Steel Bldg - BLD Application - 2/8/1978 BUILDING PERMIT APPLICATION j9�
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED '� �7 7
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER ` a S-
DIRECTIONS
TO JOB SITE 'V , ,,� o?�?,�-G ` rz 16-<<
( E ATTACHED SHEET)
LEGAL
DESCR.
NAME MAIL ADDRES CITY&STATE LICENSE NO. PHONE
CONTRACTOR i ' —p�
USE OF
BUILDING
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
!� r
Valuation of work: $ PLAN CHECK FEE S q Lo PERMIT FEE J—V
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLAN CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
Aanc,,e�Tflerewith. ZONING
/ HEALTH DEPT.
F PUBLIC WORKS
ROAD DEPT.
B _
Lic. No. �/�::A� ��r Dateeve
7� '
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTF
Owner Date. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O.
PLOT PLAN
ADDRESS ��jp �y (�'�/ ��el�<<�„ .� � 1 PERMIT NO. f o
m D
LEGAL
a o
0
DESCRIPTION LOT 2 2— BLK ADDITION S At"t 1 N
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 V
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'
3/
� e
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 OWNERS) OF SITE & STRUCTURE(S) (PRINT) C NA TU OF OWNERS) UTH RI E EP ENTA TIVE
DO NOT WRITE BELOW LINE
APPROVED
DISTRICT AS NOTED DATE
GHE_TON PRINTIN3
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4
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