HomeMy WebLinkAboutBLD11833 Walls on Carport - BLD Application - 12/10/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
�44I,v426 5593 / - f/�
DATE ISSUED
PERMIT N0.
11933
OWNERN ME All.ADD
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. �- 6
N7 MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR 6')-7el
USE OF
BUILDING �s �C1
Class of work: ❑ NEW Ni,ADDITION A RATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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dig V �- 2 X^ oz J " !!;2& �c�
�'l�� G✓I �'rC � �P�- �S� �l� � � !7 6�'c�
Valuation f rk: $ PLAN CHECK FEE /�// PERMIT F
cf � ..
N f r y
SPEC!.AL C DITIONS: S /'
op
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE Ci
ATTACHED [_1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. 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 ❑ SHORELINES lu
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.
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 UILDING DEP /O / /p
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
begin/conformance therewit�VXa
MOTOR VEHICLE PERMIT
Owner �'" 'f to P [CATION AQCE TED BY PLANS CHECK BY APPROVED FOR ISSUANCE
L�f Y
PL CHECK VALIDATION CK. M.O. CASH /W ///III RMIT VALIDATION CK. M.O. CASH
PLOT PLAN
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ADDRESS /� �/' ✓` � Z'� PERMIT NO. f 0
= o
n >
a o
0
LEGAL a
n
DESCRIPTION LOT BLK ADDITION
� m
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 GrRAPH-SQUA E�ARE3 -
CK
Ix
I
1
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.
,e
NAME(S) OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED . / DATE J�
DISTRICT AS NOTED �`�`$'Z /
6HELTON Pi71 NTIN3