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HomeMy WebLinkAboutBLD90-26958 BARN - BLD Permit / Conditions - 1/30/2015 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHIN TON 98584 427-9670 DATE ISSUED q� PERMIT NO. OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE . GAP 0--,e 14,22 DIRECTIONS TO JOB SITE �. PARCEL LEGAL NUMBER 20 �5 © DESCR. NAME MAILADDRESS CITY&STATE / LICENSE NO IP PHONE CONTRACTOR ,_— SUS 25 5 S S#EkTG 'B7J USE OF BUILDING 51C A WORKF W NEW AD ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK 3C; X aN A pDI K%i�J � ( A3 41 Li- L k ot%Z 12 / _51-/m BEDROOMS DECKS CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WI HIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE 13&jj ,V& /0O SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT F M THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT. I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27 ND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON Als D I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR W ICH IS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WH CH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE T E WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE HEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL OM THE BUILDING DEPARTMENT. APPROVAL FROM T ILDING DEPARTMENT. X OWNER DATE X BY /_447/4_� �DATE2L?_ Vlio FOR OFFICE USE Qi4tF APPROVED APPRO ED 9 � ✓ �; DEPARTMENT YES No DEPARTMENT YES No I BUILDING VALUATION HEALTH ` PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT J D.O.T. BUILDING /p / '1/!J PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP !y PRE-INSPECTION SHORELINE �' WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE TOTAL APPLICATION ACCEPTED BY PLANS CHECK BY/4 APPROVED FOR ISSUANCE PERMIT VALIDATI N Q�T rV BY /v'�S� CASH CK MO PLOT PLAN ADDRESS PERMIT NO, C 0 = s )P LEGAL /�C't'� � "7 01„Z1566 03 / R,4CT 3 ����G��� �G�e T7Z/�C°, � DESCRIPTION LOT BLK ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDING G '4 00,0 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 HE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUI DING,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' G cC 4 1 r (0 A I L-U L- Li R I I I/We certify that the proposed construction will conform to he dimensims and uses shown above and no changes will b -Pmd./without first obtaining approval. / i NAME(S) OF OWNER(S) OF SITE#6 STRUCTURE(S) (PRINT) IG ATURE O NE lS) OR AU TNORI ED REP ESENTATIVE DO NOT WRITE BELOW THIS LI - APPROVED 00-- DISTRICT AS NOTED DATE I r J i r �r �Pe` ----- IL .� WOOL, F `f , i i a