HomeMy WebLinkAboutBLD18331 Foundation - BLD Application - 2/14/1986 BUILDING PERMIT'APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED O
PERMIT NO.
OWNER ME MAIL ADDRESS CITY&STATE ZIP PHONE
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LEGAL EvL +JW A NW s} '3ECr-a T� ^ M Z I k)o( WW3 LA), >kS E ATTACHED SHEET)
DESCR. JE?(C1911% Nib My
CONTRACTOR NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
USE OF /
BUILDINGRE5
Class of work: ^NEW ❑ ITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ EMOVE
Describe work:
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Valuation of work: $ GQ PLAN CHECK FEE PERMIT FEE���
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SPECIAL CONDITIONS:
BEDROOMS I DECKS — CARPORT [ I NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORIES BASEMENT L; OR AIR CONDITIONING.
TOTAL SQ. FT.)V FIREPLACE : � DETACHED L]
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 certyfy that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FO F F I C E 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 [ i FLOODPLAIN i
Firm
E.D. NO. S.E.P.A. i;
By Special Approvals IN OUT YES APPROVED NO
'c. o. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTHDEPT.s* Ze±3�rjn
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.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance tftcrewith. MOTOR VEHICLE PERMIT
AP ATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS
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PLOT PLAN
ADDRESS \ PERMIT NO. o
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LEGAL EnCF-PT1ILNE ! CIF 5AID NJ ►JLo '
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS — Sq. Ft. jC
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE U ,
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 OFI
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 z
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPP SQUARES ARE 5' X 5' OR 1"=20' r
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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.
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NAME(S) OF OWNER(S) OF SITE ! STRUCTURE(S) (PRINT) SIGNATURE OF OWINERM R THORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING