HomeMy WebLinkAboutBLD22127 Garage - BLD Permit / Conditions - 6/9/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED-6- 9C::2�
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE
PARCEL LEGAL]
NUMBER DESCR
NAME y MAILADDRESS CITY&STATE' LICENSE NO. ZIP PHONE
CONTRACTOR
*-1-4 .5,
4!�W;25< vOeIA 64ACKI 766 qK43 2.14�-SWT7
USE OF
BUILDING
CLASS OF NEWADDITION ALTERATION REPAIR MOVE E REMOVE
,-WORK I
DESCRIBE
WORK
BEDROOMS— DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS— TOTAL SQ.FT. — GARAGE CONDITIONING.
NO.OFSTORIES — 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. � FIREPLACE— DETACHED tw� ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT le�-- SHORELINE ----
SEASONAL—
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS OR 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 CONFORM CE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING ROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FR THE BUILDING DEPARTMENT.
X OWN X BY DATE
v FOR OFFICE USE ONLY
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES NO BUILDING VALUATION
HEALTH PUBLICWORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
p SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
C Ula-j BY CASH CK MO
PLOT PLAN
ADDRESS &-601A-2� IO, 111U/7H OW L(Ji4 PERMIT NO. f o
LEGAL N b i A Iq .s`7� `" '_eF
DESCRIPTION LOT 777 BLK ADDITION fi.°
SITE AREA /5' 46 ZjL' Sq. Ft. AREA OF SITE OCCUPIED BY BUILDING Sq.Ft.
INSTRUCTIONS TO APPLIC NT A
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN T SCALE OF NOT LESS THAN 1"-20' AWE
1\
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUS HAVE A SEPARATE PLOT PLAN.) v,
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUI LDING,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'
Jp
L
G,
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
P
NAME(S) OF OWNER(S) OF 317E s ST RUCTUREl3) (PRINT) SfGNATUjK OF OWNERS) OR AU THORIZ REP ESENTATIVE
DO NOT WRITE BELOW THIS INE �
APPROVED DATE
DISTRICT AS NOTED