HomeMy WebLinkAboutBLD28703 Convert Carport, New Carport - BLD Application - 7/29/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO
NAME MAIL ADDRESS I ro h CITY&STAT ZIP PHONE
OWNER 2 n 1`4) W,-15 j o •t l u 4k lR a- YS e l 4v,, ,,�, .i
DIRECTIONS nn }-
TO JOB SITE Z� N'Iiru- C'In AI P*s4 � t� cS' --Q-
PARCEL LEGAL
NUMBER 0/k-1,2-0 0/D DESCR. � /-I /1VC 2
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF L BUILDING c C7V1 V�4 lrV C/I t' c 0. G/j+r0. t IL 614 Jd- CZ 111
CLASS OF NEW -r d I ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK er.c A �C iJ�• 2-
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS SgFt BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT_'t SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 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 THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL EAQM THE BU DING DEPARTM T. C� APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNER DATE /� XBY DATE —
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING > AQ FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING "�' PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
c SHORELINE
WOODSTOVE
L PLUMBING
MECHANICAL
STATE BUILDING FEE �}
PPLICATION ACCEPTED BY PLAINS CHECK BY MB
R ISS ANCZSH MIT VALIDATIONle
CK MO TOTAL
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 oAr issuEo
PERMIT NO.
NAME MAILA 0 3b L/ T CIT A E ZIP PHONE
OWNER I K eti�, i�►.100d 0% � 10 ,7S36 a�.l�ck R� Sic Idfl•� lc. A 7,rSSY 26-S7' 6
7o oe s TE .Z"�. l Au v,-, R-j' P � s
PARCEL LEGAL 1 NUMBER G�� 014 -12 -060 ID I OESCR. I Sew *A-C-he-4 P&ece- 2—
Indicate below: O Procer,y lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area or sewer.
O Septic tank and drainfield setback distances from foundations.
�I O Location of proposed construction on property.
/ O Building & septic system setback distances from all property lines & easements.
Indicate North O Well and water line.
O Saltwater, takes, rivers, streams,wetlands,drainage. -
In Circle O Attach copy of septic system"as built"or septic permit-approval.
O Indicate topography profile of property and structure on reverse side.
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TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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