HomeMy WebLinkAboutBLD19358 Storage Bldg - BLD Application - 9/24/1986 b BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
4265593 DATE ISSUED!
PERMIT NO.
bW R NAME MA LADORESS CITY& TE DP PHONE
DIRECTIONS
TO JOB SITE K
j LEGAL !
DESCR. AA L it) WHO
NAME I MAILA Ud-&%A-TaE LICEN P PRONE
CONTRACTOR
USE OF
BUILDNNG
CLASSOF NEVy ` ADDITION ALTERATION REPAIR MOVE REMOVE
WORK: r
DESCRIBE
WORK
BE MS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL so.FT. GARAGE 1R CONDITIONING.
NO,OFSTORIES J: BASEMENT ATTACHED THIS PERMIT BECOMES NULLANDVOro1FwoRKalcoNem)crioNAUtHORMisNoT
COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Is SUSPENDED OR
TOTAL SO.FT. FIREPLACE_ DETACHED ABANDONED FORA PERODOF UID DAYS ATANYTIMEAFTERWORK SCOMMENCED.
PERMANENT SHORELINE`"—^
SFJWONA J_
YOWNEAFFIDAVIT CONTRACTORS AFFIDAVIT
HAT IAM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CUWMMY REOISTOW CONTRACTOR RN THE STATE OF
N LAW ROWASV,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON ANC I AM AWARE OF THE 1 /B1'TS.Rl6lMTINO:THE
NTS FOR wHICI+THIB PEWMr7181SSUFDAND THAT ALL WORK DONE WILL BE WORK FOIE,WHICH TILE PERMIT 18 MBU ALL VITORK D w WILL BE IN
THEREWITH. NO CHANGES.SHALL BE MADE WITHOUT FIRST CONFORMANCETHEREWITH.NO CHANOEB SHALL BE MADE WITHOUT FIRST OBTAINING
ALFROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
DATE X BY DATE
F 6F 00 F I C E U 1QNLY
APPROVED
DEPARTMENT YESAPPROVEDO DEPARTMENT YES No BUILDINGVALUAIITON
HEALTH PUBLKTWLIRKS FEE
PLANNING FIRE - BUILDINGPERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTI0I4
G/ SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE �•�"�
STATE SURCItW4E
APRICITKNIAOCEPTEDSY PIANSCHECKSY APPROVED FOR ISSUANCE PERMITVAIIDATION
By CAS MID TOTAL
PLOT PLAN
'sOSEPR A. QALAIWO
ADDRESS PERMIT NO. i c
MCA SWVRTSt S♦ C_ UDL �/W PAW $# o
LEGAL$EC,'?382A/76 22 N a3 N�
DESCRIPTION LOT BILK ADDITION a
SITE AREA ! Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS i./ 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 A"'D 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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s
I • `M'�r
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I/We certifythat the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
P P� 9
first obtaining approval.
T a
NAME(S) OF OWNER(S) OF SITE k STRUCTURE(S (PRINT) GN R OF WN R OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BE4l W TH S LINE
V
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING