HomeMy WebLinkAboutBLD27587 Addition - BLD Application - 2/28/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES 1
P.O. BOX 186 SHELTON, WASHINGTON 98584 CO`
427-9670 DATE ISSU
PERMIT NO. D-1
NAME MAILADDRESS CITY SSTATE ZIP PHONE
OWNERDIRECT
ONS
TO JOB SITE / b �vu�t L
PARCEL LEGAL
NUMBER 3 Gl�� ��ato-cam DESCR. Sti SJY��>C,�5 ate_ k�aY•�.�� aLNeJu.�s� Caw. oY ►1 ,0� . 1�1) �1K�r,,
NAME MAILADDRESS CITY RSTATE LICENSE NO. ZIP PHONE
CONTRACTOR j r� Ge (3 l i+�s. 5-L 64 ►��-R�. �Lt I T2 PLI3N0l'1'8w.
USE OF •
BUILDING T_,4 pi Tid L4
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r I/
DESCRIBE i
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORI ES 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 SO.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL%'
OWNER AFFIDAVIT 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
REGIST ATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUI MENTS 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 C FORMANCE 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. /
WNER DATE X BY DATE
FOR OFFICE US ONLY
DEPARTMENT YES
SPPROVE NO DEPARTMENT YES NoBUILDING VALUATION -yew
HEALTH PUBLIC WORKS FEE
PLANNING FIRE o -.20-7 BUILDING PERMIT Q
D.O.T. BUILDING (J� ,(' PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
45 SHORELINE
WOODSTOVE
irlo W 7^uf_ W liC 7'e-rC 1 � PLUMBING
3v f UtJ MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION l
TOTAL `!
1
0. CASH CK MO `
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER .t-c 'lovkLcw - S,$66 iteL Kd 9LYf cl t126-7W
DIRECTIONS /I //r
TO JOB SITE �.�. -Weer ef' i•F 9�• jc cl
PARCEL LEGAL
NUMBER �i9�`l a�alb DESCR.
Indicate bel w: O Property lines and dim sions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
0 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.
In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage.
O Attach copy of septic system"as built' or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
� u l
Af
f
o
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.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
1 DISTRICT AS O ED �p�� DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
14