HomeMy WebLinkAboutBLD284 Replace Piling and Dock - BLD Application - 8/30/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 3 C� 2 9
PERMIT NO. �Sf
OWNER NAME MAIL AD RESS CITY&STATE ZIP PHON
��— F rrse4 9 F M S o N )< LIP— , R P6 ►e-aI a/
DIRECTIONSf� T 1
TO JOB SITE O)J �C AA C n1� 0A17 I a A I4- � IA—Y i—v f L/a l,- c
LEGAL /� (❑SEE ATTACHED SHEET)
DESCR. MADIN6 S'uA)XJ Yt1Ou.c Abo , 4 CT
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR S L F I
USE OF
BUILDING
i
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION KREPAIR ❑ MOVE ❑ REMOVE
Describe work: (�
t2 Qr_Pc `�" o t tt_ tN 6 2 Fats OF 17vr� k AM,46SD
Valuation of work: $ . V/ PLAN CHECK FEE PERMIT FEE
X
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I] OR AIR CONDITIONING.
[ITOTAL SQ. 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 f_1
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.
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
Date. 3
td 5 APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
IIECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
� PLOT PLAN
1
_ADDRESS �/ 0 'V''qsfl^� "�<<£ �JZ� akAf V( E =J PERMIT NO.LEGAL
4 0
a o
;� ) n
DESCRIPTION LOT A-'f) , 10 I t�A 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 GRAPH SQUARES ARE 5' X 5' OR 1"=20'
CS
#44
S►�o'�L
I/We certify thli the proposed construction will conform to the dimensions and shown above and that no changes will be made without
first obtaining i pproval.
PR.ecot LIM( P,topar2y'Y L��t
NAMEIS) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING
J
Y" MAS
ON COUNTY
426-5593 'BUILDING DEPARTMENT N° 535
ALL PERSONS ARE HEREBY ORDERED TO AT ONCE
STOP WORK
On these Premises at ................._..............................................................
Klea
....................._.....
............................................................................................................---------------------...----------....................----------------...................-----............_.....
This order is issued because .............. .......................- _.....
................................................................................................................._.......----.............................-----........................................................_...........
A.M.
Posted ..........................................P.M. ............................................................ 19.................. BY.........................................................
WARNING The failure to stop work, the resuming of work without permission from the
Building Official, or the removal, mutilation, destruction or concealment of
this Notice is punishable by fine and imprisonment.