HomeMy WebLinkAboutBLD10142 Carport,Storage Shed - BLD Application - 3/5/1981 i
y BUILDING PERMIT APPLICATION
• i
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED — �
ZJz1 PERMIT NO.
OWNER NAME MAIL AD R SS CITY&STAT�� ZIPN)ivi
PHON
DIRECTIONS 1 11
TO JOB SITEu�y-j
FLEGAL ` ,, ' 1 TTACHED EET)
DESCR. `� E�2 ��� /K� ' SG./ E
NAME MAIL ADDRES CITY&STATE LICENSE NO. PHONE
CONTRACT -71
R � � i
USE OF
BUILDING 77 7-a a!iBG'
Class of work: NEW El ADDITION El ALTERATION ❑ REPAIR El MOVE ❑ REMOVE
Describe work:
�2 20 J
�zaxac�
` rQ�
.� - •r < �''_ — 1 r !i � � v .— '�
Valuation of rk: $ PLAN CHECK FEE PERMIT FEE
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SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT _ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGED
TTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES A
BASEMENT Ei � OR AIR CONDITIONING.
TOTAL SQ. FT.,2Zg, FIREPLACE F' DETACHED Cl
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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. PERMANENTiL SHORELINES ❑
SEASONAL Li FLOODPLAIN
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 ertify that I am exempt from the requirements of the FIRE MARSHAL
ontract 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 &ROP��AESe in conformance therewith. HICLE PERMIT
N ACCEP NS CHECK BY APPROVED FOR ISSUANCE
BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
4 T PLOT PLAN �Z 1Zl 3/ L61D
ADDRESS _ A)r 2 ��V f//� rrl�:,s LJ/� {�� g PERMIT NO. �� /`c� 0 o
5'C-J�/q/ �2i` r4:j� 3/L/ ew-Z GJ w ol 17 a b
LEGAL (i✓. �ii liW�.2 7�7� S�Z .�E/Y $flyT .2 I IGs'3/�/ .�-�Wes?
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS
INSTRUCTIONS TO APPLICANT
i .2/0,;K,?/o
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
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION TH REOF.
ID I ATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
r.'
s 1s 3� 35 u ks SZ �i 65 7w 'X -50 S5.719� 9� �'✓ .oS /��' /KT �s ,zS /�� i
oo
.a
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1
<S
30
3s
a
„Js
s;7V
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EE
l<S
60
6�
9s
I/We certify that the proposed construction will conform to the dimensi n and uses shown above and that no changes will be made without
first obtaining approval. 2
f
N S OF OWN R(S) OF SITE !1 STRUCTURE(S) (PRINT) IGNA TUR OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE S
DISTRICT AS NOTED
6HELTON PRINTINi -