HomeMy WebLinkAboutBLD223 Carport - BLD Permit / Conditions - 8/22/1979 Johnson, Allan W. #223
8-22-79
act 4 of NE'k SE4
3 Box 400 Old Belfair Highway.
Carport
$2, 250. 00
/��,,,,.��lYJr /O/d 9/7 Si �i
BUILDING PERMIT APPLICATION
A MASON COUNTY �// (//�
P.O. Box 186 Shelton, Washington 98584/22/7 7 ( Q V
426-5593
DATE ISSUED 4P' 79
PERMIT NO. 02��
OWNER N E MAIL ADDRESS CITY&STATE ZIP PHONE
_ R
DIRECTIONS
TO JOB SITE &, _
LEGAL (❑SEE ATTACHED SHEET)
DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY STATE LICENSE NO. PHONE
USE OF Y
BUILDING (.�, 1044
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ? ^/�
�✓`�i.e%CCl� �.� .7J`
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
, off
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE Ll
ATTACHED I] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE El 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 I-] SHORELINES ❑
SEASONAL ❑ FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. ❑
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 in conformance therewith. MOTOR VEHICLE PERMIT
AP LICATION ACCEPTED BY PLANS CHECK BY AP OVE FIOR ISSUANCE
Owner Date�-'.�,� ��
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION jCK. M.O. CASH
PLOT PLAN
ADDRESS CN20,6-t, 6Z-4 /GLIB PERMIT NO. °s
-- c
LEGAL Ric
DESCRIPTION J �F DLO�� BLK ADDITION
O,•
SITE AREA_ Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. C^
INSTRUCTIONS TO APPLICANT b
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- � a(
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- CA
TION AND 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.
N.
* INDICATE NORTH IN CIRCLE -
R�
t,
�I �- CJ✓
R UL
O �
C � L
'-sic 6 Him CXt rf IS
R1 E
G
v
SrEPA
o T
AI
I/We certify that the proposed construction will conform to the dlmensio'na and uses shown above and that no changes will be made without
first obtaining approval.
6/4k/s
NAME(SI OF OWNER(S) OF SITE a STRUCTUREIS) (PRINT) SIGNATURE OF OWNER(!) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE