HomeMy WebLinkAboutBLD14102 Deck - BLD Application - 6/6/1983 BUILDING PfRA011T APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �_. ;z
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
100//,0X,0 " Sl � T�0 , w y• 4 9;6
DIRECTIONS i j/,.f c'',Q1e--Y 7-3
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TO JOB SITE C O v / �, /.' 10flo cJ ejF,,C
LEGAL , (❑ SEE ATTACHED SHEET)
DESCR. A 0al I, D! 4 3 J—
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
/.1
USE OF V
BUILDING /�u f�
Class of work: ❑ NEW ;'ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: t
0 Or
Valuation of work: $ 1041, o / �O Q PLAN CHECK FEE PERMIT FEf�ao.��
SPECIAL CONDITIONS:
e A40 c r w 7Ti /°os T Mary .D�'.ps
/3 /J 16eA s,i.r �.,/ ,c bF 3G " i6 i6 .vo v -v iLyo 'c T,61 od?.
BEDROOMS I DECKS� CARPORT [] NOTICE
BATHROOMS TOTAL SQ. FY'�" GARAGE LI
ATTACHED L; SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF��STOR��II/ES BASEMENT [] OR AIR CONDITIONING.
TOT �SZ]. FT. FIREPLACE X DETACHED f
GGi�s diY� 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. PERMANENTD SHORELINES
SEASONAL �I FLOODPLAIN 1_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. rp 3
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
/ LIGATION AC P E BY., PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date .4 `L �`�,.�
PL CHECK VALIDATION CK. M.O. CASH P MIT VALIDATION CK. M.O. CASH
1
PLOT PLAN
ADDRESS 1— 01+(/,6 Li /�� /?10 PERMIT NO. o
s
LEGAL DESCRIPTIONO/ — a
Z" LOT BLK ADDITION
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS JbfQ Sq. Ft. r
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 ARID 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. F3
e
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Cad
tt
i
1/We certify that the proposed construction will conform to the dlmensichs and uses shown above and that no changes will be made without
first obtaining approval.
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/UA/, 0 � . /9/9j/0 A�
NAME(S) OF OWNERS) OF SITE d STRUCTURE(S) (PRIN T) �IGNA TUBE OF OWNERR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
TRICT AS NOTED DATE
TON PRINTING