HomeMy WebLinkAboutBLD9109 Sign - BLD Application - 11/24/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED //�
ZZ 3 2 �� v V200 PERMIT NO. .z
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE ff/&/j/WVy
LEGAL / Q (❑ SEE ATTACHED SHEET)
DESCR. TO)1;7e r 2 Z T S. 2 Z 7 3'I
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR ,?let9W
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT LJ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE []
ATTACHED l7 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE G DETACHED
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 IJ SHORELINES LJ
SEASONAL Li FLOODPLAIN iJ
Firm E.D. NO. S.E.P.A. C
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. // ,t
of the Mason County ordinance requirements forivy
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOT R VEHICLE PERMIT
APP I TION ACCEPTE Y PLANS CHECK BY PR VED FOR IS UANCE
Owner Date . 8Y
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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LEONARD HOHMANN
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LEONARD HOHMANN
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APPROVED
MASON MAI f INM' INSPECTOR
•. PLOT PLAN
ADDRESS 7r C-7`�/� PERMIT NO. 4
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LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA )� Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS c' c'Q' 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.) N 3"I
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF 1�
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 POW f�
TION THEREOF,
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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) IG TURE OF OWNER PS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
AS NOTED �� ��
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DISTRICT AS NOTED e .7 p DATE f/
6HELTON PRINTIN3