HomeMy WebLinkAboutBLD28020 - BLD Permit / Conditions - 5/3/1991 � �� a - � aa CC)Q3 a
Shorelines: Plu mb ins:
Setback: Mechanics -.
Special Interior:
Conditions: FINAL:
Mobile
Smoke Detector:
Footing: Remarks:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE GARAGE
Permit No. 28020 No. Floors Sq Ftg 280
Owner SEI Tel- T-7578 Date o'er 3-91 —
Address 5219 Bubbling Well Lane, Lacanada CAZip
Contractor Great Habitations INC.
Address Gip, Harbor ZiD
Legal Description 32-23-4 Tr 3C Tr 4 SP 1727)
Direction to project site Lake Cushman rd to mile marker
6 turn left on dive wav
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage
Basement soft Other
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.',
NAME MAILADDRESS CI d ��,��� S ZIP PHONE
OWNER f? C'/� 9 (4 " -7
DIRECTIONS Q y �
TO JOB SITE +
y'C
RCEL LEGAL � ,7# -�,
NUMBER 2„�ryJZ 2 DESCR. / .-Cj /� ._'/.
NAME Z�4DDRESS CITY&S TE LICENSE NO. e ZIP j, HONE yrJ
CONTRACTOR . wb
USE OF
BUILDING
CLASS OF ADDITION ALTERATION REPAIR MOVE REMOVE
NEW
WORK ✓
DESCRIBE ,-
WORK Y��
CARPORT NOTICE
BEDROOMS — DECKS Y OR N TOTAL SQ.FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS---- TOTAL SQ.FT. TOTAL SO.FT. CONDITIONING.
NO,OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
BA COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
LIVING AREA SEMENT ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
TOTAL SQ.FT. — TOTAL SQ.FT. CHECK ONE
PERMANENT FIREPLACE ATTACHED
SEASONAL— SHORELINE DETACHED— --
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REGISTRATION LAW RCW 18.27, AND AM
REQUIREMENTS FOR WHICH THIS PERMIT A ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE
THE BUILTH.NO CHANGES DING SHALL BE MADE WITHOUT FIRST OBTAINING
LDING DEPARTMENT.
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE
X BY f �KATE--.� _—,�----
FOR OFFICE USE ONLY
APPROVED APPROVED BUILDING VALUATION Lj ` ell,
DEPARTMENT YES No DEPARTMENT YES No
FEE
HEALTH
PUBLIC WORKS S
� FIRE BUILDING PERMIT
PLANNING
D.O.T.
BUILDING Z' PLAN CHECK
SPECIAL CONDITIONS
BUILDING GROUP - PRE-INSPECTION
SHORELINE
rf n ►7ti i }L '�, � WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPROV D FOR I,S UANCE PERMIT VALIDATION 't
APPLICATION ACCEPTED BY PLANS CH6G)K BY TOTAL
` / `/'( BY (.!% CASH CK MO
PLOT PLAN
PERMIT NO.
4 s
ADDRESS >
`
15ij4Ubll��fll��y 'n
LEGAL n ADDITION °
DESCRIPTION LOT L
BLK / - u
SITE AREA /1 I`" f Sq Ft. AREA OF SITE OCCUPIED BY BUILDINGS_—�T—� 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 AND SEWER SERVICE ELEVATION. SH(iW 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
, i
V L(
II_ n
t
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 OWN ER/al OF SIT E 6 aT RUC TUREl3) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED