HomeMy WebLinkAboutBLD4011 Storage - BLD Permit / Conditions - 11/12/1976 Ridge, Marcella #4011
II-12-76
Tr. 13 SW-SE 9-23-1
Move 12 x 12 Storage Shed
$500.00
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BUILDING PERMIT APPLICATIO
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED � /7
PERMIT NO. Op`G
OWNER n NAM7E MAIL ADDRESS CITY&STATE, ZIP PHONE
-� 1 `' i✓I /� a 3oS�
DIRECTIONS I �/
TO JOB SITE /(d Y✓1 i�!° 5v 'L U'r Ida -C.ren,� /.f,�Q He -7)`�
LEGAL / � (O SEE ATTACHED SHEET)
DESCR. —� —I /_ / 3 s(41v - s&
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF Cl
BUILDING R'1_Vt,` I F,_
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR XMOVE ❑ REMOVE
Describe work•
Valuation of work: $ PLAN CHECK FEE PERMIT FEE D
SPECIAL CONDITIONS:
APPLICATION CEPTED BY PLANS CHECK BY AP P O ED FOR I UANCE Type of �— Occupancy Division
Nt 1 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
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
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 AFTER
Owner 1���j'15� ti---L-Dat WORK IS COMMENCED.
IDIAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. c o
= o
n >
� o
LEGAL
DESCRIPTION LOT BLK ADDITION
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 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
It
r I,
I/We certify that the proposed construction will conform to the dimensims and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNERM OF SITE S STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE