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HomeMy WebLinkAboutBLD26887 Addition - BLD Permit / Conditions - 10/9/1990 Shorelines: Plumbing: Setback: Mechanical: Special Interior: Conditions: FINAL: MobileHome: Smoke Detector: Remarks: ooting: Setback: Foundation Walls: Framing: Fireplace: Wood Stove: TYPE ADDITION Permit No. 26887 No. Floors Sq Ftg122 Owner THOMPSON, ROBERT B. Tel 7�351 Date- Address 1319 Lakeshore Dr Centrailia Zip Contractor Norm Zucati Address Zip Legal Description AyocK Beach lot Direction to project site z mi n. o i iwaup Ayocl< Beach house on end ot poinT kGray wifn TiaL, roof) Plumb ing Mechanical Sewer Wood Stove Fireplace Deck Tarage arport Basement loft Other X X — BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. � NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER Co -D,T 4, l Owl .rO,,u 131 4 LctL! !rorc t'Q-. Esc DIRECTIONS 'ele TO JOB SITE l o.v s cam-, �., o �� �:�� 6�a w /•=/�7— oe 1a PARCEL LEGAL NUMBER 3?303 51O 9 ,10/Z DESCR. Lo7-1Z A ock 6«4- li- NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR �/ 2 USE OF BUILDING CLASS OF NEW ADDITION '� ALTERATION REPAIR MOVE ! REMOVE WORK r DESCRIBE WORK e 6v a o ,0 BEDROOMS DECKS YOR N CARPORT NOTICE TOTAL SO.FT. DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. TOTAL SO.FT. CONDITIONING. NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT FIREPLACE ATTACHED SEASONA SHORELINE DETACHED OWN SAFFIDAVIT CONTRACTORS AFFIDAVIT I CE MY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGI TRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE RE IREMENTS 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 ONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING O AINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE 1© g X BY DATE FOR OFFICE USE ONLY Y APPROVED DEPARTMENT APPROVED BUILDING VALUATION �) DEPARTMENT YES No YES No HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION SHORELINE it S WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE , ����,��4rr STATE SURCHARGE APPLICATION ACCEPTED BY E OR I PLANS BY APPROV ANCE PERMIT VALIDATION BY CASH CK MO TOTAL , PLOT PLAN ADDRESS � -s c 4 O C �� �G: C �. T- PERMIT NO. 0 ` p/ 4 /V ,CJ n D J � D O O D LEGAL N DESCRIPTION LOT Z BLK ADDITION4,0 C v, !'tt C w. u 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 A"ID 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' sec we-f~ e � 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. NAMED OF/)OWNER(SI OSITE � lUCTU S)(R1�) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE _ APPROVED DISTRICT AS NOTED DATE SHELTON PnIN7IN3