HomeMy WebLinkAboutBLD26531 Repair - BLD Permit / Conditions - 8/24/1990 as ��
PlLmbing:
Shorelines: Mechanica
Setback: Interior:
Special FINAL:
Conditions: Mobile ,cme.
Smoke Detector:
Remarks
Footing:
Setback
Foundation
Walls:
Fr aping:
Fireplace:
(„food stove:
TYPE U2&L —
rs Sq Ftg 3U—
Permit No. LB-il No. FlooTel Date B—
owner
irnit�N ('QiiniTRY ST(1RE�
----r Zip
Address
Contractor 1p _—
Address
Legal Descriptlon
Direction to project site
Sewer Wo Stove
Mec anica arpo rt
P m ing —
Fireplace Deck arage _
soft Other
Basement — —
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 /� g
427-9670 DATE ISSUED U 077 ~ o
PERMIT NO. C;76\5731
NAME !J�/id.✓ G0I LAI'r4)A CITY&STATE 3 O H W ZIP PHONAJ!O
OWNER f Al%"� /�-- S
DIRECTIONS ,DOA✓A/ rat4 �A/1�
TO JOB SITE
PARCEL ^ c �/ LEGALJ A-PX_ ON L S � D 4L
NUMBER 2z3 [S O DESCR. Zs LO i, - 1G U 4J) Ll Lt
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PH NE
CONTRACTOR S
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION Q EPAIR I MOVE REMOVE
WORK r n y�1 xx
WORK DESCRIBE FiQ A,1 G"C Q
3 s OJ9 6
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS FIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTR ION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS 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 Co
ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
OWNE DATE -�� -� 6 X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION ( CJ �
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT 'Z
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE S
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY AP ED SSUANCE
� PERMIT VALIDATION
-7 TOTALJJ1
11 " � /- BY CASH CK MO '
PLOT PLAN
ADDRESS � �� � PERMIT NO. -2 i�a �
2 o
A •
LEGAL
DESCRIPTION y LOT F BLK ie ADDITION
SITE AREA �7 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. 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I
I
/
I! a certi hat the rop-W fonstr coon will oogform to the dlmaneidtta and uses shown above and that jo changes will be rtfade without
first obtai ing approval.
N AMEIII OF OWNER(a) OF SITE STRUCTURE(S) (PRINT) IGNA RE OF OWNERISI OR A� ORIZED REP ESENTATIVE
DO NOT WRITE BELOW HIS LINE
APPROVED
DISTRICT AS NOTED DATE
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L PLAT OF UNION CITY ,
J 3 2 , T. 22 N. , R . 3 W., W. M. �\ �' 106
COUNTY , WA.
YSTE M EASEMENT
)PERTY OWNERS WEST , N880E 27.84
MORRIS ET AL. TO
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BLOCK 8 a w o N8H E TS.00 VACATED ALLEY
4, o0 0 20 FT. WIDE
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O - SET REBAR I EASEMENT
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763 SD. FT. STORE
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