HomeMy WebLinkAboutBLD11073 Addition - BLD Permit / Conditions - 7/23/1981 HAUGEN, David #11073
St. Rt.* 3, Box 167, Belfair 07-23-81
Old Belfair Hwy to Newkirk to Riverhill - 1 block on
riverhill, gray house to right
SW1/4 NW1/4, 21-23-1
Addition Contractor - Self
$11,520.00
r y BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �—
DATEISSUED
PERMIT NO. Z/ 73
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
JD
DIRECTIONS / bLoa.F a� /��✓✓�'��
TO JOB SITE 'l �j�� 1
LEGAL ^ (n S ATTA E SHEET)
R /— �
NAME UAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR r
USE OF
BUILDING � �
Class of work: ❑ NEW '1<ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ r PLAN CHECK FEE PERMIT FE c�
c�
SPECIAL CONDITION .
BEDROOMS DECKS CARPORT i NOTICE
BATHROOMS TOTAL SO. FT. _ GARAGE [I
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [j ATTACHED I OR AIR CONDITIONING.
TOTAL SO. FT.,&,W FIREPLACE !7 DETACHED 1
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. PERMANENT SHORELINES , r
SEASONALI FLOODPLAIN ❑ A
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
1 certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT. ? $ 2
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MgT.QQ VEHICLE PERMIT
`,� /Date . PPL TI CEPTED Y PLANS CHECK BY APPROVED FOR ISSUANCE
Owner G",/ e
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
.. - .- PLOT PLAN
ADDRESS PERMIT NO. o
Z o
n >
s o
0
LEGAL
DESCRIPTION LOT BLK ADDITION o
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 P"ID 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'
r
- ,
T
)
V
I/We certify that the proposed construction will nfor to the dimensions and uses shown abov and that no changes will be made without
first obtaining approval.
r
NAM (S) O OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) IGNA TORE OF OWNERS) OR AUTHORIZE REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED 7 J DATE
DISTRICT AS NOTED L)a
6NELTON PRINTING