HomeMy WebLinkAboutBLD N/A Concrete Strips and Tie Downs - BLD Permit / Conditions - 5/15/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
Y . ' _ / PERMIT NO.
OWNER N%M E. MAILADDRESS CITY&STATE ZIP PHONE
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ONS
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PARCEL I LEGAL 1- f- 'I
NUMBER i.?,3,3 p 5.2_0001,-f I DESCR. `Q 0
NAME MAIL ADDRESS CITY&STATE LleENSE NO. ZIP PHONE
CONTRACTOR '"�DLI aClCL�`7 IpO /�.� _ i ��!//�./ dCC�I &oq
USE OF
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BUILDING S'/�Q��rtC D 6 I / / �} I /� me, `� eel' ei'
CLASS OF
WORK NEW ADDITION ALTERATION ✓ REPAIR MOVE REMOVE
✓ ,�,,// �
WORK IBE cooc/Cl� a,--)( - /nk'Aa // Ceoo !L /�„/
BEDROOMS DE KS Y R N CARPORT NOTICE
TOTAL SQ.FT.
BATHROOMS DECK GARAGE CONDITIONING.EPERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ.FT. TOTAL SQ.FT.
NO.OF STORIES BASEMENT Y OFYIN THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TJI/ TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT IREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTfFY THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X N i J'r- `l'D X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH -3i- PUBLICWORKS FEE
PLANNING(. ` FIRE BUILDING PERMIT
D.O.T. BUILDINGOIC �''3/"fv CJ,� PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
L � SHORELINE
r ` %.p/ �, WOODSTOVE
�� � � 'jr 17 �, t •� ,. � �G � �� �. PLUMBING
X q a x %�%�= DG� C1 _ �G' MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION /
��_ TOTAL
BY�y �C CASH CK MO
PLOT PLAN
ADDRESS NE /47/ L-(.t,/s0k7 Lk, L&I PERMIT NO. 0 0
6?j A-- ' �o
LEGAL '
DESCRIPTION ► V tS LOT BLK ADDITION
SITE AREA._e&,2,LN AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft. V
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE N vl
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) (LI S
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF 0
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- �V
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.
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Shell .,
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72
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fI We certify that the proposed construction will conform to the dimensidne and uses shown above and that no changes will be made without
f rrt obtaining approval.
NAME(S) OF OWNER(S) OF SITE ! 3TRUG URE13) (PRINT) I TURE OF OWNERM OR AUTHORIZE R P !EN ATIV
DO NOT WRITE BELO THIS LINE
APPROVED DATE
DISTRICT AS NOTED