HomeMy WebLinkAboutBLD20049 SFR - BLD Application - 7/29/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
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51 426-559(3 DATE ISSUED �'
��2 PERMIT NOI- 7
OWNER SAME M IL ADDRESS CITY&STA ZIP PHONE
DIRECTIONS
TO JOB SITE c i 5 � '- "— 5" 6r s7'LEGAL
AF
}mil 1
DESCR. _C 4E;
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR _
USE OF _
BUILDING f .5 f )i-vu,c c
CLASS OF NEW �, ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE ,/ t
WORK 34/%jl7. = �I /, /� 00
.c c
BEDROOMS DECKS CARPORT {,/ NOTICE
���(� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE ' CONDITIONING.
NO.OF STORI ES`� 2- BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT.&O FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT G SHORELINE lZ
SEASONAL
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
REGIS ATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
RE EMENTS FOR WHICH THIS PERMIT IS 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 THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
O TAINING APPROVAL FROM THE BUILDING DEPARTMENT, APPROVAL FROM THE BUILDING DEPARTMENT.
OWNERS ?-? DATE A�Zl X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION n,
YES NO YES NO L4C
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT `
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP k"_3 PRE-INSPECTION
SHORELINE
J
PLUMBING -517,
MECHANICAL z
STATE BUILDING FEE Q
STATESURCHARGE ,APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
l�Yr�% BY4 CASH CK MO TOTAL
PLOT PLAN
r
ADDRESS Cam.
PERMIT NO. c c
4 u
1/7
LEGAL
DESCRIPTION LOT BLK ADDITION
CAW
SITE AREA 1 L1-;.r100 Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS 11 1LZ- Sq.Ft. 0
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 Pt"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/CS= FOR 1"=
_ h
' J
I�
^:1
I
100
� y\J
I/We certify that the proposed construction will conform to the dimensions and uses shown a ve and that no changes will be made without
first obtainingapproval 7
�� ���- ( '� � ��. L�;�
NAME(S) OF OWNER(S) OF SITE h STRUCTUREIS) (PRINT) GN RE F WN R( ) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BEL W HIS L E
APPROVED
DISTRICT AS NOTED DATE
6NELTON PRINTING