HomeMy WebLinkAboutBLD9381 Shed - BLD Application - 1/30/1981 -� BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
32i3q _ ,5 _W, tJ 5593 DATE ISSUED
PERMIT NO.
OWNER MAIL A DRESS CITY&S AT ZIP PHONE
DIRECTIONS
TO JOB SITE
Y
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. S- #;
N SS CITY&STATE LICENSE NO. PHONE
CONTRACTOR d
USE OF
BUILDING —
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: 8,N ac ay. D,G, 3
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE
32 y
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT [] NOTICE
BATHROOMS TOTAL SO. 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 1 J SHORELINES I.J
SEASONAL [] FLOODPLAIN I
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
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 NG DEPT. / 30 8�/
of the Mason County ordinance requirements for .
which this permit is issued and that all work done will ROAD A CESS
be in Conformance therewith. MOTOR EHICLE PE IT
�J��� '�� _ APPLICAT N ACC BY PLAN CHECK BY PRO D FOR SS ANCE
wne .� Date Y
K� 1
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. UPASH j
I
PLOT PLAN
I
ADDRESS PERMIT NO.
o O
A D
LEGAL
DESCRIPTION WNW. LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
1% 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.
I
r; INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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p
1
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I/We certify that the proposed construction will conform to the dimensions and uses shown above and hat no changes will be made without
first obtaining approval.
NAMEM OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) NA UURE OF WNER(S) OR A ICZ ED R IRE TATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6MELTON PRINTIN'
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