HomeMy WebLinkAboutBLD20036 Remodel - BLD Permit / Conditions - 3/30/1987 TYPE REPAIR
permit No. 20036 No. Floors Sq Ftg _
Owner HART, Larry R. Tel 898-2516 Date 3-30-87
Address E 7931 Hwy 106 Union Zip
Contractor Self
Address Zip
legal Description Tr 18 G.L.3 4-22-3
Direction to project site .7 miles East of Alderbrook
Inn. Yellow house on left side of b1gz-
ing X Mechanical X Seer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
CHANGE OF FLOOR PLAN. NEW ROOF, GOING OVER EXISTING
ROOF
Shorelines: Plumbing: 74n T y"I 7 2&,
Setback: Mechanical:
Special Interior:
Conditions: FILL: eeler, � 7
Mobile ome:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls: CO
Framing 7ijW2 r 0___ _ _o_L_`_7
Fireplace:
Wood stove:
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED,_:5-':�?6-c?7
PERMIT NO.C,-:24:520
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER /ZT 4Ae4i e.1,c
DIRECTIONS
TO JOB SITE ,y
PARCEL D LEGAL �r / t
NUMBER #,3 - L1�d� DESCR. c �O Jx
NAME MAILADDRESS CITY BST E LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR ,/ FM
OVE REMOVE
WORK ✓ /�
DESCRIBE
WORK
BEDROOMS DECKS f CARPORT -11S NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ. FT. GARAGE i72C CONDITIONING.
NO.OF STORIES BASEMENT -110 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. lB FIREPLACE 7 DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT tAkO SHORELINE
SEASONAL
OWNER FFIDAVIT CONTRACTORS AFFIDAVIT
I CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIS ATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQU EMENTS 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT INING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X WNER �[- DATE �}'(f! z � . 1 y�J X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENo BUILDING VALUATION C CQ o
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT y O
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
Nd ex��rhr exati sim- L- SHORELINE
WOODSTOVE
PLUMBING 6
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
AP LIGATION ACCEPTED BY PLANS CCH CK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
V< remit L/ BY CASH CK MO TOTAL
PLOT PLAN
ADDRESS IflS 71f � f�/moo / /Q ��� 'F�4� y0� � PERMIT NO. o
Z o
LEGAL p °o
DESCRIPTION j kA61 u
_ �,�LOT - y- a?—�' BLK ADDITION
SITE AREA _4 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'
V
C.
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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 AME(S) OF OWN R(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF-'OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
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