HomeMy WebLinkAboutBLD85-18160 SUN ROOM - BLD Permit / Conditions - 11/25/1985 rGOUSEISUMOM
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BUILDING PERMIT APPLICATION
MASON COUN Y
P.O. Box 186 Shelton, Washin 'on 98584
426-5593
DATE ISSUED //�02 �)
PERMIT NO.
NAME MAIL ADDRESS CITY&ST E ZIP PHONE
OWNER , Vi2.. Ak ,e= 7 w�rA,vv De „¢ .._
DIRECTIONS ® �J L
TO JOB SITE ®LQ' S A ` C/_PST �C /f7 clrco/ T I ��
(❑SEE ATTACHED SHEET)
LEGAL
DESCR. �
NAME MAIL ADDRESS CITY 8 SP
LICENSE O.f�/L L1f17
CONTRACTOR LO4
T 'v
USE OF
BUILDING
Class of work: ElNEW 2rWDDITION ❑ ALTERATION ❑ REPAIR ❑ OVE ❑ REMOVE
Describe work:
bk -n� srn off'
r /1 616
Valuation of work: $ PLAN CHECK FEE PER MI FEE o
SPECIAL CONDITIONS:
BEDROOMS I DECKS ,CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_/ BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. 1 FIREPLACE ElDETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR F CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD O 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS CON MENCED.
the State of Washington and I am aware of the FOR OFFICE U E ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in SHORELINES
conformance therewith. PERMANENT ❑
!/ SEASONAL ❑ FLOODPLAIN
Firm I��CJi'JS cUy,� �U/isfieuC/�'�7 E.D. NO. S.E.P.A. ❑
Special Approva S IN OUT YES APPROVED NO
By A
Lic. o. G/PSD/ / $,jZ Date ZONING
PLANNING DEPT.
HEALTH DEP (t_ � 4E
OWNERS AFFIDAVIT
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSH
contract or registration law RCW 18.27, and am aware BUILDING DE V
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHI LE PERMIT
APPLICATION A EPTED BY PLANS CHECK BN APPROVED FOR ISSUANCE
Owner Date . BY
PLAN CHECK VALIDATION CK,. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING
i
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1
PLOT PLAN
ADDRESS / L ('C ��.!iM(--> (7� i/(<"pe i 1 PERMIT NO. o
= s
n f
LEGAL -
DESCRIPTION LOT /`i BLK ADDITION
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICAN
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"s20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAk E A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BU LDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST OOR ELEVATION, STREET ELEVA-
TION A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WA R, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE F EACH BUILDING AND MAJOR POR-
TION THEREOF.
ti INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I F(F y% 14) ?tr- t
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I/We certify that the proposed constiuction will tnform to the dimensions and uses shown above and that no changes will a made without
first obtaining approval. U'
�1
NAMES) OF OWNERS) OF SITE k STRUCTURE(S) (PRINT) IGNATUi� OF WNER(S) OR AU MORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS L/NE
APPROVED
DISTRICT AS NOTED DATE