HomeMy WebLinkAboutBLD9748 Loading Dock - BLD Application - 1/3/1980 McKnight, Gordon #9748
1-3-80
Tr. 14 NW SE 29-23-1
Old Belfair Hiway next to Thriftway Complex
Dock (Loading) (Commercial)
$1,600.00
1 Z3 2 � cR
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BUILDING PERMIT APPLICATION
MASON COUNTY /2_7Z� VZFOZZ7-/
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER , NAME MAIL ADDRESS TY 8 STATE ZIP PHONE
It
DIRECTIONS {�
TO JOB SITE Q �( t'� I' k))q l I�/� Tp h r 1���l� lam a&'-
LEGAL (❑ SEE ATTACHED S EET)
DESCR. ,J �// ticu $vFjK
a —
NAME MAIL ADDR SS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING C> mVy)e 1,
Class of work: ❑ NEW XADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work* � O C'
Valuation of work: $ /'OQ PLAN CHECK FEE w yd PERMIT FEE
WW �
SPECIAL CONDITIONS:
BEDROOMS — DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
NO. OF STORIES BASEMENT Ci
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE [J 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 U SHORELINES I
SEASONALIi FLOODPLAINI
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
�jt d O — APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Ow /' Date . BY
+(ZLv✓L�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K M.O. CASH
PLOT PLAN
ADDRESS C �Q /7 /�FPf�, PERMIT NO. z
s °
V °
LEGAL r;
DESCRIPTION)1� 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.) r
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF i
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION A"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL M,
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 51*-W OR 1"=20'
i
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( /We certify that the proposed construction will con rm to the dimensidns and uses shown above and that no changes will be made without
first obtaining approval.
NAMES) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE