HomeMy WebLinkAboutBLD23523 Final Workshop - BLD Permit / Conditions - 4/7/1989 a� BUILDING PERMIT APPLICATION
(� MASON COUNTY
\� DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
U� 427-9670 DATE ISSUED
U PERMIT NO. 3 Sa-3
OWNER NAME MAILADDRESS FITY&STATE ZIP PHONE
j _( .a
DIRECTIONS
TO JOB SITE
PARCEL LEGAL I •�
NUMBER�� &'3�/ DESCR.��, ��/ S �D•.PO� S=a3 -
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
.S
USE OF
BUILDING a�y�
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ ADDITION
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE f� CONDITIONING.
NO.OF STORIES _ BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS FFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRA ION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE ENTS 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 CON RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X ER �"'' �L`�.`C DATE �� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT Y SPPROVEDIO DEPARTMENT YESPPROVEDIO BUILDING VALUATION G'�U
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT O
D.O.T. BUILDING PLAN CHECK Z `i
SPECIAL CONDITIONS BUILDING GROUP 114--2 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE ,
APP (CATION ACCEPTED BY PLANS CHE K BY D APPROVED FOR IS ANCE PERMIT VALIDATION
� d�' BY dam' CASH K MO TOTAL �a �5
PLOT PLAN
ADDRESS /� - /e ?a ��- PERMITNO S3 0
s
s o
e
LEGAL f X
DESCRIPTION / ^
LOT ,�P � ��/ �� 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 AND 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.
-1
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"-20'
O -/
S
I 1
I/We certify that the proposed construction will conform to the dimetpialr+s and uses shown above and that no changes will be made without
first obtaining approval.
NAMEIa or OWNER(S) OF SITE a STRUCTURE(S) (PRINT) I N T R OWN(S ) OR AUTHORIZKO RKPRKSKNTATIVK
DO NOT WRITE QELOW THIS LINE
APPROVED /'_ 7-g7
)STRICT AS NOTED DATE 7
l
Shorelines: IVA Plumbing:
Setback: Mechanics --.
Special Interior:
Conditions: FINAL: 4
Mobile
Smoke Detector:
Remarks:
Setback: d
Foundation
Walls: Dec
Framing:
Fireplace:
Wood Stove:
TYPE WORKSHOP
Permit No. 23523 No. Floors Sq Ftg 432
Owner WIS avid L Tel 5-4218 Date 4-7-89
Address NE 2151 Bear Creek Rd Brem r Zip
Contractor belt
Address Zip
Legal Description E,SW S of Co. Rd. 5-23-1
Direction to project site Above address BPlfair
Plumbing Mechanical weer Wood St5ve
Fireplace Deck Garage Carport
Basement ----1,oft tether