HomeMy WebLinkAboutBLD8260 Final Enclosed Porch - BLD Permit / Conditions - 9/5/1975 Adduddell , Royal H. _ #8260
8-1-75
Mission Creek, Lot 10, Block 3
Enclosed back porch attached to mobile home
$900.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE ISSUED —� J
PERMIT NO.— F2-4 `'
-- --- MAIL RES T'P - PHONE
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OWNER'
. --—- -- - ADO Z 1� � -70 r
DIRECTIONS G
TO JOB SITE UP --1 1 ub G �i
LEGAL Atl ADO ESS 21P
(QSEf ATTACHED SHEET)
DESCR.
- MAIL ADDRESS PRONE
CONTRACTOR S Q_ F�
USE OF /MAIL ADDRESS PNONE LICENSE NO.
BUILDING �� 12G�- �/
Class of work: ❑NEW j.ADDITION ❑ALTERATION ❑ REPAIR O MOVE O REMOVE
-- Describe work:
Valuation of work: $ QQ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION AC,: TE BY PLANS CHECKED BY APPROVED FOR ISSUAPACE BY
Type of Occupancy
A nst. `T Group Division
v � T
_ ize of Bldg. No.of Max.
Total)Sq. Ft. Z Stories Occ.Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State 7UNING
of Washington and the County of Mason and I am aware cf the HEALTH DEPT.
ordinance requirements regulating the wcik fcr which the permit PUBLIC WORKS
Is issued and all work done wi;l be in conformance therewith. OAD DEPT.
Firm
By ---
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract-
or registration law RCW 18.27, and am aware of the Mason N 0 T I C E
County ordinance requirements for which this permit is issued
and that all work done will be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
/ AUTHORIZED TON OR WO K IS NOT SUSPENDED D ORIT ABANDONED HIN 120 SF U
OR A PERIOD OF
�. 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
,,---PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHELTON PRINTING CO.
PLOT PLAN
ADDRESS
PERMIT NO. o 0
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_/ ,� F, 7 ICI D
LEGAL M J SS �1 [/--CJ� l V IJ LIe• p a
DESCRIPTION ' LOT BLK ADDITION
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^'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.
lv INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
r.
Ilk
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I/We certify that the proposed construction will conform to the dimensions us s wn aboJB and that no changes will be de without .r
first obtaining approval.
NAME(S) 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
SHE LION PRINTING
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