HomeMy WebLinkAboutBLD2020-00740 REVISION - BLD Application - 12/7/2022 �_e,5 ues�#��FQ:r_Revi�;�`o z o F =e p= abed Mans.
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Permit Numb Bl_ /OM: - 40 Applicant Name �JT-�� Email:
Phone#:aU Lo'100 Project Title'.?i/iT Parcel Number:�223�1-32 •fly()
Please provide a complete, detailed description of the pro ed revisions to the approved plans. Please
return this form to the Mason County Permit Center.
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The following documents are required to be submitted with this form.
➢ One set of revised plans or addendum indicating the changes. Yes No
➢ One set of the approved construction plans. Yes_✓ No_
(The"Red Stamped"approved site plan must be included)
➢ Revisions are to be clouded with delta's clearly and accurately identified
on the revised plan/s or addendum. Yes_ No_
➢ Does the plan contain a structural, architectural or soils engineer analysis? Yes_ No_
(If yes,has the Registered Professional/s approved this revision) Yes_ No_
(Is a stamped and signed approval included with this request) Yes_ No_
(If no engineering or other changes requiring a registered professional have been
made,the plan may be approved without written consent of the engineer or ` 1
architect of record) �'j I
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➢ Does the proposed revision modify the footprint or location of the structure/s? Yes(/ 0-
(if YES, is a revised site plan,with all new setback dimensions included with this request?)
Yes_ No_
Additional Information: `
Applicants Signature: Date: i ! 'L 2,
STAFF REVIEW SECTION
Reviewed by:
Department Date Assigned Date Reviewers
for Review Received Reviewer Approved Approval Odgi Valuation: $
i� h Additional Valuation: $
Building JC6 t711 q
1 JIL, Sq. X $
Sq.Ft. X $
Planning 'G, c.L
-/ Additional Fees: $
01 Additional Plan Review: $
Publi Additional Building Permit: $
He h Additional Plumbing: $
Additional Mechanical: �� $
Fire Other.
Marshal ��� ` 1-/oroo
otal Due: \ $
Public
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