HomeMy WebLinkAboutBLD21483 Barn - BLD Application - 2/2/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 p 427-9670 DATE ISSUEd��//Jj�rl
PERMIT NO.c��
OWNER NAME
MAIL ADDRESS CITYSSTATE ZIP PHONE
DIRECTIONS QU cv�-- -C..,. -
TO JOB SITE
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V'<D c uc
PARCEL
NUMBER / LEGAL
D Desc m7 £/fi,/�mf �o.z�fi� Ti�erS �or �3�NAME
CONTRACTOR AIL ADDRESS CITv&STATE LIULINSE NO. ZIP PHONE
USE OF I ��- 5 - �'� A
BUILDING
CLASS OF
WORK r NEW v ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE ?
WORK 3JrJo ZffJC
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SO.FT. SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
-- CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SO.FT. _3 FIREPLACE DETACHED COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
PERMANENT � SHORELINE
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
_J
SEASONAL
OWNE SAFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTR 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 NTS 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 F RMANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININ APPROVAL FROM THE BUILDING DEPARTMENT.
APPROVAL FROM THE BUILDING DEPARTMENT,
X OW R DATE 2 0 Pa. r ] X BY DATE
T
FOR OFFICE USE ONLY
DEPARTMENT APPROVED
YE O DEPARTMENT APPROVED
vss BUILDING VALUATION �
HEALTH PUBLIC WORKS
FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK Ed
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
/ ` SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK $$
�^B APPROV OR/ UANCE PERMIT VALIDATION
\,'\ BY I(1�,v) CASH CK MO TOTAL
PLOT PLAN
ADDRESS PERMIT NO. o
t �
w
LEGAL °o
DESCRIPTION LOT BILK ADDITION
SITE AREA 1 ALA(!- Sq_0! 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.
® INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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I/Wes certify that the Proposed construction will conform to the dime lions and uses shown above and that no changes will be made without
first obtaining approval.
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N♦M[(tl OF OWN[R(t OF SITE a STRUCTURE) (PRINT) SIGNATUREOF OWNER1a1 OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE B LOW THIS LINE
APPROVED 1� 4 I DATE
DISTRICT AS NOTED