HomeMy WebLinkAboutBLD4298 Final Addition and Deck - BLD Permit / Conditions - 2/5/1981 Pope, John & Alice #4298
3-15-79
Tr. 18 NW 1/4 SE 1/4 29-23-1
At end of dead end road between Thriftway & PSN Ban]
Addition & Deck
$3,340..00
ti,
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
3 ` DATE ISSUED & -%J=7 cJ
1016• ��`'� -2 PERMIT NO.
OWNER AME % MAI DDRESS CITY&STATE ZIP PHON
P r
DIRECTION
TO JOB SlY z2-/-e�)fy
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. �r�/� / p;7-- r2
NA E , MA L ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR _
USE OF
BUILDING C!! sf�1�1� — A/ ayu-y`u' �e�uL �.�o—•� � - �j
Class of work: ❑ NEW VADDITION ❑ ALTERATION ❑ REP -(R ❑ MOVE ❑ REMOVE
Descri a work:
G• �Cl�t/+ C;�—��EJ .�/Rey �� .(ems
Valuation of work: $ � � PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
J
BEDROOMS DECKS 0 CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT.IJ60 GARAGE ❑
ATTACHED ❑ LSEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIESA BASEMENT ❑ AIR CONDITIONING.
TOTAL SQ. 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 ❑
SEASONAL ❑ FLOODPLAIN ❑
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in ,3nf rmance there
wit MOTOR VEHICLE PERMIT
Owner �LZ Date 25 / APPLICATION ACCEPTED BY PL S C ECK BY AP OVED FOR ISSUANCE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
1 PLOT PLAN
ADDRESS PERMIT NO. f o
n s
A OO
LEGAL
DESCRIPTION LOT BLK ADDITION "a
SITE AREA Sq.Ft. AREA OF SITE QCCUPIED 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'
I
. l
I/We certify t at the proposed construction will conform to the dimensidns 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
SHELTON PRINTING