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HomeMy WebLinkAboutBLD22122 Bulkhead - BLD Permit / Conditions - 6/9/1988 qC)( ) 50 Shorelines: Plumbing: Setback: Mechanical: Special Interior: Conditions: FINAL: MobileHome: Smoke Detector: emarks: ooting. Setback: Foundation Walls: Framing: Nun P BY EXPIRATION Fireplace. �� Wood Stove: DATE a-k ` TYPE BULKHEAD Permit No. 22122 No. Floors Sq Ftg 33q Owner BROWN, Donald Tel 275-5080 Date 6-9-88 Address NE 12421 Northshore Rd Belfair Zip Contractor Self Address Zip Legal Description Tr 5 G.L.6 35-22-3 (Tr D S/P 1126) Direction to project site 1 - A miles out of Belfair on Northshore Rd. Above address Plumbing Mechanical Sewer Wood Stove Fireplace Deck Garage Carport Basement Loft Other BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED -0 PERMIT NO. 2 �� E K, Z `M�111LADDRESS CITY&STATE PHON�_c^ � OWNER � �'�. r �? DIRECTIONS _ t TO JOB SITE PARCEL LEGAL T17- 5 ©P 0 0 Y t-�-� ( Tf4'K NUMBER '�..C�J '; 3 "gCUJfJ DESCR. < d{= c1" ►\ " - k) .l } S E MAILADDRESS TY&STATE LICENSE NO. ZIP PHONE CONTRACTOR � v ' - USE OF BUILDING CLASS OF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK BEDROOMS DECKS CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTALSQ.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 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 CON ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH,NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAIN G ROVAL FROM THE BUILDI DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. l � X O - DATE ZS 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 U D.O.T. BUILDING PLAN CHECK P. SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE l� WOODSTOVE PLUMBING MECHANICAL �i JC d 37 X y C" �tj = ���� STATE BUILDING FEE STATE SURCHARGE j'0 APPLICATION ACCEPTED BY PLAN CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION /� TOTAL r/ z �" _a �� _ BY �� o CASH CK MO `I J �-5, T o V 6 ap �? y SPA' . 5 r PLOT PLAN ADDRESS \V �,}r `� C� �� fo7�U" PERMIT NO. ? _ s LEGAL K 17 O(Z c+ ':SIEC DESCRIPTION L4EK Bt1E ADDITION SITE AREA a( Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS `v 1 -_Sq. Ft. r INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' AgE 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 POW TION THEREOF. `}; INDICATE NORTH IN CIRCLE r��, GRAPH SQUARES ARC 5' X 5j0R 1"=20' _ r(1 � O , +j/ ^' I f' y 0 I/We certify that the proposed construction will conform to the dimensidns and uses shown above and that no changes will be made without first obtaining approval. l_ n � AME(a) OF OWNER(a) OF SITE'! ST RUCTUREl3) (PRIN TI I T OF OWN Rf3) OR TMOR �Z O REPRESENTATIVE DO NOT WRITE BELOW THIS LINE J APPROVED DISTRICT AS NOTED DATE Don & Barbara Brown NE 12421 North Shore Rd Belfair, WA 98528 �y IV G r J �. f k3 #4 ��