HomeMy WebLinkAboutBLD6936 Garage - BLD Permit / Conditions - 7/21/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED—
PERMIT NO. ' (�
DAME MAIL ADDRESS
OWNER D a �� C CITY&STATE ZIP PHONE
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DIRECTIONS c c
TO JOB SITE 3 5d`t-e
LEGAL (❑SEE ATTACHED SHEET)
DESCR. i ��� L/t-ra;I
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CONTRACTOR NAME MAIL ADDRESS CITY S STATE �� 7 PHONE
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USE OF
BUILDING C-cx -5- ,rc 2 11— —-1 is Jr Z
Class of work: `§rNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ o,_ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE [I
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SQ. FT. FIREPLACE ElDETACHED ❑ OR AIR CONDITIONING.
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
certify that I am a currently registered contractor In WORK IS COMMENCED.
the State of Washington and I am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
Firm SEASONAL ❑ FLOODPLAIN ❑
E.D. NO. y.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
-DateJ ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
( be in conformance therewith. M(?fOp VEHICLE PERMIT
Owner A ATION ED BY PLANS CHECK BY RO ED FO I UANCE
Date. Y
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(,eLIDATION CK. ^•SFl PERMIT VALIDATION CK. M.O. CASI,'
PLOT PLAN
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ADDRESS I � �/ I ('� C-� PERMIT NO.
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LEGAL
DESCRIPTION "/0 LOT BLK ADDITION u
SITE AREA-3 0-c——QO, Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS 0 Sq.Ft.
0-U0 $I ( 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 P•ID 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.
AM
DICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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I/We certify that the proposed construction will conform to the dimensioru and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE k STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
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DISTRICT AS NOTED
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