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HomeMy WebLinkAboutBLD9404 Install Time and Temp Sign - BLD Permit / Conditions - 2/7/1978 f S1 � � yRums APPLICATION MASON COUNTY n P.O. Box 186 Shelton, Washington 98584 - � h, eY ham+ T `-y DATE ISSUED ��Z� I PERMIT NO. y OWNER NAME / AIL DDRESS CITY�ASTATE � p ZIP PHONE wttnV" 3S DIRECTIONS , /f ` 3 TO JOB SITE H /n A LEGAL n (❑ SEE ATTACHED SHEET) DESCR. `� �`/—v2 3 " �/�- �] NLcI E- NAME MA ADDRESS/ CITY&STATE LICENSE NO. PHONE CONTRACTOR 01�. GbMncc or USE OF BUILDING S,✓+f S P L..c, Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: �5-7 i�-- -N60AT0 sic Z YJ z i Valuation of work: $ J/, CP©U PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: Vo/ n-JL— APPLICATION ACCEPTED BY PLANS CHECK BY AP ROVED FOR ISSUANCE Type of Occupancy Division B 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 COMP, PUBLIC WORKS By ROAD DEPT. Lic. No. Date 2--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 of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING, 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 OWn'—Date. WORK IS COMMENCED. 1 PLAN C ECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN 12 3Z,2- �1_zax�b ADDRESS PERMIT NO. 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 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 THEREOF. f INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Ij 70 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 OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE 1 6MELTON ..INT1Ns