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Home My WebLink AboutBLD Application - 6/20/1989 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAILADDRESS CITY B.STATE ZIP PHONE OWNER /0�/ DIRECTIONS TO JOB SITE PARCEL LEGAL NUMBER . 'Z -��'Ykf1 DESCR. /7Q0.(/A�02it`SlOG`f�lf1,TACrI �U7 7 b�/.c= T�- NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR Z�kES;;',2E "AA 11-?aell*d "fo1c %o.Sb' 7Y;3ejz USE OF BUILDING CLASS OF NEW X ADDITION X ALTERATION REPAIR MOVE REMOVE WORK DESCRIBE WORK /V 4f�L�C! .5� TD, ,p�'r OBE cv/TF� o,� >/•'c E.9!7 s,oc 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 OF180 DAYS AT ANY TIME AFTER WORK IS COMMENCED . PERMANENT SHORELINE SEASONAL OWNERSAFFIDAVIT 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 FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE 6—� _ X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL IBY CASH CK MO PLOT PLAN ADDRESS /!/.G1 PERMIT NO. o � a /Ji9d.8v.v.9 /�d,�ti'%:v�.'S�4E e4c'i9cf1 i2�9ci.� ��.�GfG �fil�AldC"•C � o LEGAL •3�23 -SO-CJ�Ol7� �^ DESCRIPTION LOT 7 BLK ADDITION 1 SITE AREA G 2?2T -"e— Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS/9.�G7�G��EYi`6�7Sq. Ft. INSTRUCTIONS TO APPLICANT �p 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.) i 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. Z �i N INDICATE NORTH IN CIRCLE GRAPH SQUARES A-RE-5' -5' OR 1"=20' (� y ` � t I s � s I/We certify that the proposed construction will conform to the dimonsiohs and uses shown above and that no changes will be made without first obtaining approval. �C./�C/�. � �OyT j �• NAME(SI OF OWNER(a) OF SITE a STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(a) OR AU HORI ED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE MASON COUNTY DEPARTMENT of GENERAL SERVICES Courthouse Annex I N. Fourth & W. Cedar P.O. Box 186 Shelton, Washington 98584 (206) 427-9670 building environmental health maintenance landfill parks&recreation fair/convention center planning sewer&water DETERMI ATION OF NONSIGNIFICANCE (WAC 197-11-340) Description of Proposal: I vc,L' b'S l ' /S �� 1:51r-&Ia d,, 7 �O� Proponent: _ location of Proposal, inclining street address, if any: lead Agency: The lead agency for this proposal has determined that it does not have a probable significant adverse impact on the environment. An Environmental Impact Statement (EIS) is not required under RCW 43.21C.030(2)(c) . This decision was made after review of a completed Environmental Checklist and other information on file with the lead agency. This information is available to the public on request. There is no cannent period for this DNS. This DNS is issued under 197-11-340(2) ; the lead agency will not act on t7is proposal for 15 days from the date below. Comments must be submitted by Responsible Official: 206-427-9670 Position/Title: Telephone: Ext 366 Address: Date: Signature: CC: