HomeMy WebLinkAboutBLD6017 Pump House and Utility Storage - BLD Application - 3/13/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 J /1
426-5593 3 //3 i�(✓
DATE ISSUED
PERMIT NO. �601_7
OWNER NAME MAIL ADDRESS CITY&STATE / ZIP PHONE
If
DIRECTIONS
TO JOB SITE LARECTLIV AQjR0,6 04 F N a E
LEGAL IF
S /C� (❑ E ATTACHED SHEET)
DESCR. 4Q S /Z V / I- 'A
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: AYNEW ❑ ADDITION ❑ ALTERATION ❑ EPAIR ❑ MOVE tl REMOVE
Describe work:
Valuation o work PLAN CHECK FEE PE I EE
SPECIAL DITIONS:
BEDROOMS DECKS CARPORT [] NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED i� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. 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 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 I
SEASONAL (I FLOODPLAIN I i
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
APP ICATION CCEP Y PLANS CHECK BY A O ED U E
net Date O BY
HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN /2 Z r N
ADDRESS 12 MIRWAJ, PERMIT NO. /4/ 0 f o
= o
n s
a o
LEGAL LOT • 3 29 r l
DESCRIPTION LOT BLK ADDITION LA
u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.,?4?'C
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.) AS
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.SHO ATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF. Y�O��
y
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
i
I
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 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRE NT TIV
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE S.—�d
I SHELTON PRINTIN3