HomeMy WebLinkAboutBLD9205 Dock - BLD Application - 9/14/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 ,/
DATE ISSUED q—f 7` " 7�
PERMIT NO. 9o�QJ�J
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
G I.
DIRECTIONS
TO JOB SITE h
LEGAL JJ (❑ SEE ATTACHED SHEET)
DESCR. J�T " ?Z 6' J�U 71 71 /Ov, � U L /
CONTRACTOR NAME MAIL ADDRESV CITY&STATE LICENSE NO. PHONE
USE OF J
BUILDING Po G/
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEEAr
/
E 5�
SPECIAL CONDITIONS:
BE OMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT� GARAGE El
ATTACHED ❑ 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 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. Ll
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. Li L3 MOTOR VEHICLE PERMIT
Owne Date./7��O -�/ APKICATION A CEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION �CK. M.O. CASH
i
PLOT PLAN
4/t'-e di- r%t
ADDRESS �� a ` h /O �7 . PERMIT NO. 0 o
� �r �>ur, Su �Z y 3 f� :P � o
a o
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LEGAL
DESCRIPTION �� y� LOT VI 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.
G
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
V
(
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 SITE • STRUCTURE(S1 (PRINT) SIGNATURE OF W E (�R/AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE r
APPROVED
DISTRICT AS NOTED DATE
I 6MELTON PRINTIN3
J
426-5593 MASON COUNTY
BUILDING DEPARTMENT N- 534
ALL PERSONS ARE HEREBY ORDERED TO AT ONCE
STOP WORK
On these Premises at
This order is issued because _::.._..
..........................
Posted A.M.
..........................................P.M. ....._..................................................... 19.................. By -----------.._......_.......---------•----•---------.....
IIVARNIIVGThe 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.