The URL can be used to link to this page

Home My WebLink AboutVOID- Add Garage - BLD Application - 10/13/1989 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. OWNER NAME MAILADDRESS CITY& TATE ZIP PHONE DIRECTIONS ,n /0 TO JOB SITE �;q/ p = 16c) l3 cl)&ppz I IPARCEL LEGAL u Gros 1 NUMBER�o?DI D SCR.1604gp IV4�) S&)Fif 16- V49. NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR se if USE Ray, K Ca r BUILDING CLASS OF NEW ADDITION ti/ ALTERATION REPAIR MOVE REMOVE WORK r WORK DESCRIBE Ad 4 a- 16 ! a,eeoq e h EX) 5 1.$ I l7 J �6 12 BEDROOMS_ DECKS PORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING. NO.OF STORIES 1:_T::� BASEMEW -�/ ATTACHED NN THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT. FIREPLAC DFTACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SFPRELI E do SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM T REQUIREM S OF TH CO RAC RS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27,AND AM AWARE OF THEM N COU Y O NCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL RK NE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE T UT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. n X OWNER DATE l03 X BY DATE FOR OFFICE USE ONLY Ar DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO r HEALTH 144k, PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT < S� D.O.T. BUILDING PLAN CHECK �� --- SPECIAL CONDITIONS BUILDING GROUP rn_I PRE-INSPECTION L � !N` � SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE AFC STATESURCHARGE APPLICA N' 42 ACCEPTED BY PLA S CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION 4 • GL�tif�v- ,8 -• O CASH CK MO TOTAL C__ rcv5in / �ZOICP - 3a - cIOI �C� PLO�PLAN ADDRESS "0�Q SAd A M4 f 6c ll �Cr PERMIT NO. 010 • '-16q016 3 a LEGAL ' DESCRIPTION LOT BLK ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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 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. SHriW 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' VA �C M I 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. n vF (' 11�a� 11 NAMEIa) O OW Rla) Osl E --� a STRUCTURE($) (PRINT) IG ATURE OF WNERIS) OR AU N (ZED R ESEN ATIV DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE // � Z i /W,oq TC/,e/J .e G r% tiT CA-), SI G N {Jvs �Si; a iP!CoNT O1J GRR � .. Do-S lLSpim��71.'� Pa�P�r1 3 rv�Q,ES • OO TRR�cEC ADD�T ��rco o� X ru ?b,rt/ s� oC)A 0 film � o (94appea W6020 Shelton Matlock Road Shelton, WA 98584 =7- NU) S4-J X WMN E-UIl NNG IMPEC' -��. 5 r N eq, W6O2O Shelton Matlock Road Shelton, WA 98584 NW s �k Ape"G, ilz� ;� a � I�i4SON �1111 riIP,IG � HSPECTOP, ".•T TO RPPROViA1 S? K rujW6020 Shelton Matlock Road Shelton, WA 98584 06 I t 1 J t ' go �- l�� s cd k Ld® � � �� 13 J��d�fr Z')� ier'i to V"N EUMING INSPECIU3, '^;TO APPROVAL W6020 Shelton Matlock Road 7� hellon, WA 98584 � -?e,,P SSG 1 f i rf � D S' �UP s'1N �FING I PE p "T Tt TO PR s ��