HomeMy WebLinkAboutBLD9654 Water Tank - BLD Permit / Conditions - 11/26/1979 Mt. Rainier Council - # yG
Boy Scouts of America II-26-79
SW 1/4 NW 1/4 4-22-3
Belfair State Park take Dewatto turn off, go to
Robbins Lake at Hahobas Scout Reservation
Water Tank
$24, 173.00
a cop /2/-61 y
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 11—a6" 79
PERMIT NO. -` A 7
OWNER NAME MAIL ADD ESS CITY 6 STATE ZIP PHONE
17114 * �hc — Bo sc.ew s o 4wer / zz 5, I/m/ 7�cv�4 (Jd 9fi y0
DIRECTIONS -F ro•.1 Lo 454,a 5 e P 4 &—if "fd P e-022 7—,5"2 - 77 ./
TO JOB SITE -PVl - &1 O GA f V Robbins L e d �- /,/,.jtia,&as SC007L -5e-p-A,;4I-4",
LEGAL �/�/ III SEE ATTACHED SHEET)
DESCR. 5 w �'f d lV Wy St-et / u/K N �,{�
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR 'I F 14'i k" Si lvoI44 woo Iffy11 k vcrsdh 3.6 Y—y9 PO
USE OF—
��,��t tZ c r %�d K
Class of work: ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
�r& c c? q l/�
o�t �l �/N4)ecar cvy cl� e c
to e>I Lo Y R vo/r A ; A
Valuation of work: $ PLAN CHECK FEE ��' PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
NO. OF STORIES BASEMENT O
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED El
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 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
SEASONAL ❑ FLOODPLAIN
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
l(y D fof 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.
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
Owner f Date�� NaG^ ' APPLICATION ACCEPTED BY PLA CHECK BY APPROVED FOR ISSUANCE
BY
ror2I't 7-kit/1((E CO C/N Gtc
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
I
► MASON COUNTY HEALTH DEPARTMENT PLEASE REPLY BY
ENVIRONMENTAL HEALTH SECTION ❑ a D
428 WEST BIRCH STREET
REGULAR AIR WIRE PHONE
SHELTON, WASHINGTON 98584 MAIL MAIL
PHONE (206) 426-5561
To .........................._.............-.-....James.._..Connolly_____..........._...._.. DATE—__No_member.__26...........19.7-9- ..
_ ..__.._.................................uilding_ D�artment SUBJECT._ Water Storage Tank
for Camp Hahobas
Shelton, Wa. 8584
Dear Jim:
The plans have been approved for water storage tank for Camp Hahobas
by D.S.H.S.
Sincerely,
Bruce Pederson, M. D.
County Health Officer
SIGNED
Marjory Dilworth ale, R. S.
Supe—se, of Envirenmental Health
MD-D:vl
RECIPIENT- Please sign and return pink copy
PURCHASE ORDER
No, 1 7 Req. No. Date`�' �� ✓ 19 7�/
To N.45606( �LAt TV Zee T- For it 5
Address P 69 i3e S'f't CZ TCIV 1. ,4 Date Required
Ship To How Ship
Address Terms
ell QUANTITY PLEASE SUPPLY ITEMS LISTED BELOW PRICE UNIT
ORDERED RECEIVED
3, 7 c�
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
IMPORTANT Please Send Copies Of Your Invoice With Original Bill Of Lading
OUR ORDER NUMBER MUST APPEAR ON ALL
INVOICES, PACKAGES, ETC.
PLEASE NOTIFY US IMMEDIATELY IF YOU ARE UNABLE
TO SHIP COMPLETE ORDER BY DATE SPECIFIED.
�% �_� Purchasing Agent
1 H 146 Redif?rm ORIGINAL
J
1
w PLOT PLAN
ADDRESS PERMIT NO. �0 o
LEGAL 5 N/Yj A//K)X S�' 1� / Ll'�1 Z ��� l•L A a
DESCRIPTION LOT BILK ADDITION
.J
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT r6
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. Q'I
J
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' f
h
Y
r'
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 OWNERM OF SITE h STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3
J
i o'.J. Box 186
Shelton, p,0Si0ingf(,n q,-,5S4
Krone 426-55�3
I
MESSAGE DATE 1 1 / 30� 79 REPLY DATE
TO
Mr. Dave Sqan
P. 0. Box 908
Belfair, Washington 98528
Dear Mr. Swan:
The check for the building permit for the
water tank came in today. I am enclosing the _
receipt. The number in the upper right hand
i
corner (9654) is the building permit number.
You may put this on the permit I gave you.
I
Thank you for the quick response you have j
taken care of this matter.
SIGNED/� �-/7� SIGNED
SEND PARTS 1 AND 3 WITH CARBON INTACT-PART 3 WILL BE RETURNED WITH REPLY.
Redifprm• 4S 473
Poly Pak 150 sets)4P473
DETACH AND FILE FOR FOLLOW-UP
__ -- - PURCHASE ORDER — —_--------.-- ----
No. 1671 Req. No. Date 1S(G L!' __
__19 -7 I
To M45001 CrClAf 7V �vt�c��•Yc� Z -1°T. Fork,f&a $4 S -
Address I0 B yd x $G 5'1'l01-7-on! W f 91 F—S-3 4 Date Required
Ship To ____ -- How Ship
Address Terms
eo QUANTITY PLEASE SUPPLY ITEMS LISTED BELOW PRICE UNIT
ORDERED RECEIVED
1 �7I// s1lE 11&_W4ti/7- 37 Po
2
3
4
5
6
1
B
9
10
11
12
13
14
15
16
17
18
19
20
21
22
IMPORTANT Please Send Copies Of Your Invoice With Original Bill Of Lading
OUR ORDER NUMBER MUST APPEAR ON ALL
INVOICES, PACKAGES, ETC.
PLEASE NOTIFY US IMMEDIATELY IF YOU ARE UNABLE
TO SHIP COMPLETE ORDER BY DATE SPECIFIED.
Purchasing Agent
1 H 146 Redilfrm ORIGINAL