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HomeMy WebLinkAboutBLD14232 Pre-Inspection - BLD Application - 6/27/1983 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 d DATE ISSUED ^I j 7 PERMIT NO. Y OWNER NAME 1 MAIL ADDRESS CITY&STATE ZIP PHONE L WI E' R 7-Z r UJ 0 DIRECTIONS �7- TO JOB SITE SS >OX/ EF_ �� /,� © /��}S I /i �� �0 Gc% C,/�✓/ E LEGAL (❑ SEE ATTACHED SHEET) DESCR. /_0 t n �� d G�1 NJ/SS / o /a C' IP NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR USE OF , BUILDING I-S 1 0 F_ /v C, C Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: dD u ef NOW PL 4P E% :,N Aff Val t c i r-At + or LAN CH • O PERMIT FEE d-U r 1 -- SPECIAL CONDITIONS L ep �/�� rTo- ga 4b BEDROOMS I DECKS — CARPORT ❑ NOTICE BATHROOMS I TOTAL SQ. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. TOTAL SO. FT. FIREPLACE Cl 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 SEASONAL CI 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. MOTOR VEHICLE PERMIT ►t,). e ,a e 3_ LIGATION EPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Owner Date. BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS /7,) I 1�J l S S it iv �` )< Q 4 PERMIT NO. $ u n D LEGAL 9 00 DESCRIPTION LOT e, BILK L/ ADDITION s, S J , c / C l'f- '� 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"'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. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' r � R 14 i c � Q � S tj t� rtify that the pro will conform to the dimensions and uses shown above and that no changes will be made without first obtain approval. NAMES) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNA TUR OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE SE O S LINE APPROVED DISTRICT AS NOTED SHELTON PRINTIN3