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HomeMy WebLinkAboutBLD87 -CANCELLED - BLD Application - 11/13/1987 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 426-5593 DATE ISSUED PERMIT NO. OWNER AME MAILADDRESS CITY&STATE ZIP PHONE LL w 7o ALvt R . -mJ -K U DIRECTIONS TO JOB SITE ,,y p.0 4A ` t_t-�J gli. - ,I 4 ± c-rrq g rah d d— iE P5 ot '-'il_ RtG1-T BCH WA Z 1 �L11 ) PARCEL I LEGAL Ito NUMBER 3gp30IDESCR.l3(o O-�� S I" F4 5fr &$ NAME MAILADDRESS CI A SE NNO. ZIP PHONE CONTRACTOR VA 5.e MjSE C*13z 4ZG'I USE OF BUILDING 6lARAG� CLASS OF N W `� A ITION I N AIR MOVE REMOVE WORK ✓ DESCRIBE ALT i WORK oct �,b- J C 1 e1 C L st®t 1 " jzeVt41 5 /O y7 ( [ •.. :�,Q �Xy� Z ' ���o ►unt J BEDROOMS DECKS CA NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING. NO.OF STORIES L -BASEMENT - HE 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. t ' FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYSATANYTIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE , SEASONAL . OWNERS AFFIDAVI CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM E MPT FROM E REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 8.27,AND AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHIG 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 CONFORMANCE THER 11TH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING A 7VALFRODATE TE X BY THE BUILDING DEPA MENT. APPROVAL FROM TH UILDING DEPARTMENT. X OWNER Z' FOR OFFICE USE ON LY DEPARTMENT APPRO D DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO HEALTH PUBLIC WORKS I FEE PLANNING FIRE BUILDING PERMIT �. D.O.T. BUILDING PLAN CHECK O0 SPECIAL CONDITION BUILDING GROUP PRE-INSPECTION b0 SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE / 'T) STATE SURCHARGE APPLICATION ACCEPTED C PERMIT VALIDATION TOTAL B CASH CK MO r� � U ILDI ' C R IT AkLlCAT101 MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 r 426-5593 DATE ISSUED PERMIT NO. AME MAILADDRESS CITY&STATE ZIP PHONE OWNER . ,LL,•�,M rjsT wt,>7o ct.ij RD 5urtrJ - �{ is DIRECTIONS rr t TO JOB SITE ; jE;—r otJ C' Q if" •. 27,• ' c k. Z— .. ,� — T� t,r`1 L%.+AgT Sir FS o+J -n-4t- RI6 BEH?CJs 2 — 5D2{ PARCEL LEGAL 10 NUMBER 3 1./ 0O 03o DESCR 3 ,-ap- - -S f Srcn -9 4s NAME MAIL ADDRESS CI &STATE ICENSE NO. I ZIP 0 PHONE CONTRACTOR M �� e qz -ri'S USE OF BUILDING 6AAGE CLASS OF N W ✓ ADDITION ALTERATION REPAIR MOVE REMOVE WORK - DESCRIBE I WORK ccrcJ cG i 4t_L Ca. eAC+t- 30 K 140 . -r Z><(r '( p .. ,i j Site ct t4R.. ijtL ,t©I. /O (- ? Cn Z,E s` �5 I _ 3 7'T D..r Z ( ( i, As J BEDROOMS DECKS- GARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTALSQ.FT: GARAGE CONDITIONING. NO.OF STORIES _L BASEMENT 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. I FJREPIAGE DETACHED_./ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE' SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM E EMPI FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW ROW 8.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REOUIREMENTSFORWHIC 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 CONFORMANCE THER WITh. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FRCTHE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE X BY ) DATE______________`1 1 FOR OFFICE USE ONLY DEPARTMENT APPROVED YES YES NO DEPARTMENT APPROVED BUILDING VALUATION NO O HEALTH J PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK 00 SPECIAL CONDITION BUILDING GROUP PRE-INSPECTION oc SHORELINE WOODSTOVE-- PLUMBING MECHANICAL STATE BUILDING FEE 3 57 STATE SURCHARGE APPLICATIONACCEPTED, C PERMIT VALIDATION TOTAL B CASH CK MO IM PLOT PLAN ADDRESS lu' lc CI..- i �l( �1.VA ' S!-4itAJ TQ (/PERMIT NO. 0 o 5�• , E. S '- � c_ � fix. Sa. ��;r OF fib. l So Gtr© emu. c� Y�. .o LEGAL C. DESCRIPTION LOT BLK ADDITION G SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS f0 Sq.Ft. INSTRUCTIONS TO APPLICANT THIS RM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE FILED ITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) L FOR N W BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF C �' PROP ED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. =1! SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION ND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVI E LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION EREOF. i-114ESE PLANS MUST FAk ON THE JOB SIT' E FOR 1NSPE TI N IND CATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' j / 4 es liii _ IIiiLII -_v _-I----- -- -- -- - w4 S P I H 4A I/We certify that t s proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining a oval. ILl1i1.M NAME(S) OF OWNER(S) O SITE & STRUCTUREIS) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE D NO WRITE BELOW THIS LINE APPROVED ► DISTRICT AS NOTED DATE __ _ } I t \ U- 1 � • N /iJ • r • cn f Cn • v r < • t � 1 S ! W } t , / L is p i J b ' o Z r 14 �vN �t 1 .rt 3 e � 1 . f