HomeMy WebLinkAboutBLD3071 Addition with 2nd Story and Basement - BLD Permit / Conditions - 9/15/1978 Gunn, William #3071
9-15-78
20-21-23-1 Tr. 13 E 1/2 NE 1/4 & W 1/2 NW 1/4
2nd driveway on left on Old Belfair Hwy.
Addition w/ 2nd story & basement
Contractor
Jack Frost
$24,205.00
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BUILDING PERMIT APPLICATION
4
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. c3O 7�
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
QaX O e�FQ.� l,�� `��'S013� 7.IF 669
DIRECTIONS ^„
TO JOB SITE �` ClT\
LEGAL d j
(❑ SE ACHED SHEET)
DESCR. aQ„"1� 023
CONTRACTOR
NAME 4AIL ADDRESS / Mel-
&STATE LICENSE NO. PHONE
k F2 o9 D,Ls T. .S�Mel—Yb A.) J iXl`C rC - o2-'T-701 kc24 AW
USE OF
BUILDING
Class of work: ❑ NEW IX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: _
�.� oZ 7 ' X
67
Valuation of work: $ PLAN CHECK FEE v)�!— PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT L NOTICE
BATHROOMS TOTAL SO. FT. GARAGE [)
ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES���� BASEMENTS OR AIR CONDITIONING.
TOTAL SO. FT.t,.7� FIREPLACE ❑ 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 1 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 a SHORELINES fJ
ff C k- i'Q OS d d*.$J, SEASONAL ❑ FLOODPLAIN i i
Firm �L/ ', ( E.D. NO. S.E.P.A. I I
By „` S rJ� Special Approvals IN OUT YES APPROVED NO
Lic. No. �' �C �^' 7�1 Date . /Y 7 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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
Owner Date.
APPLICATION ACCEPTED BY PLANS CHECK BY PROVED FOR ISSUANCE
f
1 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
l..
PLOT PLAN
ADDRESS .� Z) PERMIT NO.
aX
LEGAL
DESCRIPTION LOT fi(tl BILK 7 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 61TE 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 A-'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.
INDICATE NORTH IN CIRCLE / b GRAPH SQUARES ARE 5' X 5' OR 1"=20'
1
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t I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
1 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
6H ELT ON P.INTI 11.