HomeMy WebLinkAboutBLD58 Addition - BLD Permit / Conditions - 8/7/1979 Connors f Deiwiis #58
8- 7- 79
NE4 NW4 Sec . 3S T. 21N Rg. 3W
1� mile down Mikkelsen Rd . on Right.
Addition( Green House, Storage, Deck)
$5, 308 . 00
3,�
214
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 7" 7 J
PERMIT NO. 16-y
OWNER NAME r 5 C �M�IL ADDRESS ?d QO 3 CITY 8 STATE S �C.T a j L-4 �n8 .,PHONE
Z
DIRECTIONS ,T J 1
TO JOB SITE �.�L O•)G
LEGAL (❑SEE ATTACHED SHEET)
DESCR. A) : i U LJ .3 S GJ
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF BUILDING if-j '4'6L)-� e I;—Vi A64 4 bf-CK
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
i i Acrlil:o Z� R6 131c e /4Q Coc cfz'Coo &C C K 04.")
Fj?.a.,j% Oat O .3 o Sri -d
ValuatiA of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: 0A1`J / /�O Jk
c-o
S 3a� ry
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State ofWashington and I aware of the FOR OFFICE USE ONLY
ordinance requirements
the regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
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. 7 thehonunty ordinance requirements forwhich thissued and that all work done will ROAD ACCESS
be in` otherewith. MOTOR VEHICLE PERMIT
LIGATION?ACEPTED BY PLANS ECK 8Y APPROVED FOR ISSUANCE
Owner Date, d BY
PLAN CHECK VALIDATION CK. M.O. CASH ' PERMIT VALIDATION CK. M.O. C'
7 .
A , , PLOT PLAN
ADDRESS IU JIS �Q 010 01 PERMIT NO.
LEGAL
�'� /� �� SL'CT/v.i ��.j ` � i//� �/U 4A/d6e 3CJ s o
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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"ID 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.
INDICATE NORTH IN CIRCLE �2aP GRAPH SQUARES ARE 5' X 5' OR 1"=20'
L rS � c, � r3► cry
Zc7r�
�o
PROP
L(h1�
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 S1TE S STRUCTURE(S) (PRINT) 1IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3