HomeMy WebLinkAboutBLD9306 Addition, Remodel - BLD Permit / Conditions - 1/16/1981 Orr, Collin C. #9306
1-16-81
5 mi. no. of Shelton on Hwy 3, left on Mason Lake Rd. ,
1 mi. , right on Mickelson Rd. on dirt rd (mail box) 1/4
mi.. left to house
NW NW SW 34-21-3
Addition & Alteration
Enclosed existing garage for bedroom and add an 8 X 20
addition onto existing garage, enclose upper deck 8 X 16
$10,680.00
'3-;'13y-y2 -066/0
3/2 17 fl a?
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED zz
PERMIT NO.
OWNER NAME /� MAIL ADDRESS CITY&STATE ZIP PHONE
CD//".; l� ri 'C;` e/ e 32`/ f '4 e //a, Lv e-- `j4PsF y `!2 G-.2 4.
DIRECTIONS S .air. ,o. o S/o /f•r o� /Vu y 3 - /vLf o.+ l/ylcvv,• Ga,ro iPA/ - / ...i - ,e�, o.,
TO JOB SITE fyl� CKP/r� s /7q/ - '/y ,y,�'. - /1 o•, c1..>� izc�t!�no,% 6cr - �i •�•i� /�f'1 �+ �+or
LEGAL (0 SEE ATTACHED SHEET)
DESCR. /f/w'lY .�i�c,'�s� S�- �f S 3e/ 'T:1/y le 3 c,-,
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR S e
USE OF
BUILDING
Class of work: ❑ NEW EFADDITION ® ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: /.9 x 1_0 r'n'7 rr 011,411 >4' 4,ox"ea». o, r/ a U�di m Y�G O av' J1 oia
/e v„e 42F e op
�V
Valuation of work: $ /61 b PLAN CHECK FEE N PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS / I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ 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 I-i SHORELINES CJ
SEASONAL ❑ FLOODPLAIN IJ
Firm
E.D. NO. S.E.P.A. [i
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. 9'j�cr G
PUBLIC WORKS
/which
ify that I am exempt from the requirements of the FIRE MARSHAL 04,4.1
ract or registration law RCW 18.27, and am aware
he Mason County ordinance requirements for BUILDING DEPT.
this permit is issued and that all work done will ROAD ACCESS
n conformance therewith. MOTOR VEHICLE PERMIT
Owner _ Date.1—i6 '1/ ICATIONZ
PTE BY P S BYPROVED FOR ISSUANCE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
* 10% PLOT PLAN
ADDRESS I�� �l /;,-Y 32y Sf � �o� C�(iA. PERMIT NO. o
i o
LEGAL S" 311 7 .2/ Al A 3 w s =
n
DESCRIPTION LOT BLK ADDITION u
SITE AREA /O -LC1-1 Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS 7 j Z 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 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.
r INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
31
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 d STRUCTURE(S) (PRINT) SIGNATURE OF OWNERM OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6M 11- PRINTING