HomeMy WebLinkAboutBLD19137 Retaining Wall - BLD Permit / Conditions - 8/13/1986 C)
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
NAME
MAILADDRESS CITY&STATE ZIP PHONE
- p�
OWNER cooa 4 '�
DIRECTIONS
TO JOB SITE 10,
LEGAL ` .31U fh%
DESCR. 9 D /C' U
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF -
BUILDING eohe/•'CJ-t /{,{�C/}c,A, lily .
CLASS OF ADDITION ALTERATION REPAIR MOVE REMOVE
NEW �-
WORK ✓DESCR
WORK IBE � 0,i /�/
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEM ENT 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. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTERWORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSAFFID VIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION W RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENT OR 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 CONFORM CE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCEROVAL ROM THEREWITH.
UIILDDI G DEPARTMENT.
SHALLBE MADE WITHOUT FIRST OBTAINING
OBTAININGA ROVALFROMTHEBUILDINGDEPARTMENT. &ol
ogge-
X OW E
DATE X BY DATE 3
FOR OFFICE USE ONLY
APPROVED DEPARTMENT YEAPPROVED0 BUILDING VALUATION 0 —
DEPARTMENT YES No
FEE
HEALTH PUBLIC WORKS
BUILDING PERMIT
PLANNING FIRE
D.O.T.
BUILDING PLAN CHECK
SPECIAL CONDITIONS
BUILDING GROUP PRE-INSPECTION
It op,S 60 g r16 O Od SHORELINE
_w-m! � � ty0I � �O A..� PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE ,
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL
BY CASH CK MO
7-
PLOT
PLAN
PERMIT NO. °
ADDRESS s
w >
s °
°
s
w
M
LEGAL BLK ADDITION •
DESCRIPTION LOT
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM
OAPPLICATIOT BE USED N(EACH BUILDING S TE MUST HAVE A SEPARATE P OT PLAEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN N ARE
FILED WIH PERMIT
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. SHrW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY WINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POW
TION THEREOF.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"-20'
i
3 t
on shown above and that no charges will be made without
IIWe certify that s proposed construction will conform to the dlmeraions and u
t
first obtaining approval.
VIL
NAME(S) OF OWNERS) OF SITE • STRUC TU RE($) (PRINT) I N TUR F OWNER($) OR AU TN 1 D R ES N )
DO NOT WRITE RE OW THIS LINE
APPROVED DATE
DISTRICT AS NOTED