HomeMy WebLinkAboutGarage - BLD Application BUILDING PERMIT APPLICATK)N-
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
ERMITNO.
NAM MAILADDRESS CITY&STATE ZIP PHONE
OWNER o/✓ L{?A/c r-/F��� F /`�crr/�r MovN✓ Uit//ot/ W� 17gs9 Z
DIRECTIONS
TO JOB SITE M rLFS /3S i llqL mF/t Q Roi l Q n R
o Iv /7EQ l�l IV 4,%17 0 p — Ti-If n f?/G r(7- a N )'3?r✓HCle en W L_1qLS /S
PARCEL LEGAL f o of L o 3 6/4' 2, /VE o L�T y /a' 2
NUMBER 32" 3S-S2-a2923 DESCR. Vo�vrC L/ of [,7TS — P�g�C' �— nclrTnm
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
CONTRACTOR DoN (�c RNcr/ /» E�// /yEr�/r//yovvT/�d U/v/ov GYr� �F-5 2 - 6
USE OF �^
BUILDING GAIT
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g 9T*NDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE C
GARAGE SgFt ATTACHED O DETACHED
OWNERS AFFIDAVIT 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 CHANGE$1SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPRO FROM THE UILDIN DEP,(iRT ENT, APPROVAL FROM THE BUILDING DEPARTMENT.
OWNE DATE XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YESPPRovENo BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
17 =y� i. SHORELINE a.
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
IBY 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 MAIL ADDRESS CITY STATEZIP BONE;
OWNER off/ �l�it/C' h'� E /f'7E/z? i/Na✓v�' (//!1�,+ i/r,�^ fr 2G7 i
DIRECTIONS
TO JOB SITE i�2 P-7s 1C— ,ate,ri�iz �.v v/✓ �,; %ovr� l /9', rZ,
PARCEL I q LEGAL ' -s�✓�o�� Lo 7,3, / 2� J
NUMBER 4 223.SJ2-�f I OESCA. 6 4
((/GLvAjF y G�P21� TS - 11 fWW s-j
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
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.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system "as built" or septic permit-approval.
O Indicate topography profile of property and structure on reverse side.
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ry \
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1/We certify that the pr000sed construction wilt conform to'he dimensions and uses shown above and that no charges will be made without first obtaining approval.
SIGNA7U^nE 0=OWNER(Sl OR AUTHORIZ=� 9E?RE3ENTdTIVE
DO NOT WRITS 9=LOVi THIS LIN_
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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