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HomeMy WebLinkAboutBLD90-26035 - BLD Permit / Conditions - 6/27/1990 Plunbing: Mechanicai— Interior: Con,_; is: FINAL: - Mobile Home: Smoke Detector: ooting: Remarks: Setback: Foundation Walls: Fr aping. Fireplace: Wood Stove: TYPE Permit No. 6-27-90 No. Floors Sq Ftg Tel Address Date _ _ or_ �25 S rl�vCn f f St Contract RramArntr, Zip 9,9,312 `""� Address Legal Description ip Direction to project site Pium ing Mechanical ewer oo Stove r_eplace Deck gage —port -ement -IA ft Other XX - 4 t © lzoo t,�, BUILDING PERMIT APPLI CATION MASON COUNTY DEPARTMENT of GENERAL ERVICES P.O. BOX 186 SHELTON, WASHIN TON 98584 r 427-9670 DATE ISSUED �(i "p PERMIT NO. OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE DIRECTIONS TOJOBSITE A r E l t'`i 4-r v ' ,:Fez PARCEL / �� LEGAL NUMBER fP(X'X- DESCR. 5.96, /�.�D A/ �/S NG, `/ k/ 1,1A4 CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE USE OF BUILDINGJr CLASS OF NEW ADDITION ALTERATION REPAIR WORK MOVE REMOVE ✓ DESCRIBE /� WORK K �l /f -T BEDROOMS �_ DECKS YOR CARPORT NOTICE TOTAL SQ.FT. BATHROOMS DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR TOTAL SQ.FT. TOTAL SQ.FT. CONDITIONING, NO.OF STORIES BASEMENT Y OR40 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WI HIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT. Yoe, TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT__ FIREPLACE 1SI0!5> ATTACHED -A SEASONAL SHORELINE 20AU DETACHED 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 LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS 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 CONFORMANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE I HEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT, X OWNER 17 ATE _6a O- X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO 3-5 0 .� HEALTH PUBLIC WORKS FEE PLANNING ` FIRE BUILDING PERMIT 3 V S D.O.T. BUILDING r�3 PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION = , " 0 �= ;1 3�d f/3 i SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE �LICATION ACCEPTED BY PLANS CHECK BY APPRO ED FOR ISSUANCE PERMIT VALIDATIO BY 6p— CASH CK MO TOTAL C 6 PLOT PLAN ADDRESS PERMIT NO. o s = s w > s r o LEGAL °s DESCRIPTION LOT BLK ADDITION SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. 1 INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCA E 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. i INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' I/We certify that the proposed construction will conform to the dimansidna and uses shown move and that no changes will be made without first obtaining approval. NAME(SI OF OWNER(S) OF SITE S STRUCTURE(S) (PRINT) IGNATURE OF O NER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE