HomeMy WebLinkAboutBLD9110 Garage Change of Use - BLD Permit / Conditions - 11/24/1980rr -
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 zz y
DATE ISSUED
Ga YYA PERMIT NO. &ZeQ
OWNER 114ME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE �IYSfi WOKS an r: k t kV% 2VL'-l0 p oke-Vn_
LEGAL SEE ATTACHED SHEET)
DESCR.
CONTRACR E 0 V C-C l y' MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
f„SW of �CA w bf£ N _a- 16mcl%"3327
USE OF
BUILDING (�Q yjg 0— t1oxa,i24 Q G:f V k
Class of work: ❑ NE ® ADDI ON ❑ TERATION ❑ REPAI ❑ MOVE ❑ REMOVE
Describe work:
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\"A 6,4r CLA P Andr 11116 x a 0)
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Valuation of $ PLAN CHECK FEE PERMIT FEE S
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE);I
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED L7
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
SEASONALII FLOODPLAIN ❑
Firm
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware /� �� D
of the Mason County ordinance requirements for BUILDING DEPT. /
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. M O VEHICLE PERMIT
O AP L TION A BY P CHECK BY PROV FOR IS ANCE
Owner �,� Date. BY
o
ILAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. �j��jl f o
A O
O
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft. 0
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 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 ARID 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Yn �
lS in
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no hanges will be made without
first obtaining approval.
00 /
NAME(S) OF OWNER(S) OF SITE S STRUCTURE(S) (PRINT) S ATURE OF OWNERS AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHElTON PR:NT INS ,