HomeMy WebLinkAboutBLD22027 Remodel - BLD Permit / Conditions - 5/26/1988 Shorelines: //X Plumbing:
Setback: Mechanical :
Special Interior:
Conditions: FINAL: j
Mobile e:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing; -. i/gg,
Fireplace:
Wood Stove:
TYPE ALTERATION
Permit No. 22027 No. Floors Sq Ftg
Owner OFFICER, Sherman I Tel 877-5530 Date 5-26-88
Address P 0 Box 145 Lilliwaup Zip
Contractor Self
Address Zip
Legal Description Div 3 B1 2, Lot 10
Direction to project site N 530 Lake Surf Dr
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
4ft-55" DATE ISSUED-
5!2 7- 96 7C PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER S L D 16 ti S`r3
DIRECTIONS �/
TO JOB SITE - - Q L j V
`5 -13 _
LEGAL
DESCR.
CONTRACTOR
NAME WAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
SEA
USE OF
BUILDING
CLASSOF NEW ADDITION eLT
ERATIO REPAIR MOVE REMOVE
WORK
DESCRIBE iY II
WORK G loy
A srActoo oche cZ}L�R`g�a2i
PpjN
30
BEDROOMS 'L DECKS / CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS IF TOTALSQ.FT. //2- 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. Rqb FIREPLACE DETACHED ABANDONED FORA PERIOD OF180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CEfIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI TRATION 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAC ING APPROV ROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
L
X E 9 1JAAM1,1A D '� //4 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 5' C+
D.O.T. BUILDING l PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
c, SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE •' / �:
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CH CCKpK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY � CASH CK MO •��.
1
PLOT PLAN
ADDRESS /V Jv3 C 1� E rSC�pIC�I, aCl V&, PERMIT NO. I
z
LEGAL /�
60LDN /
DESCRIPTION hh LOT / 0 BLK 7 ADDITION ,� u
SITE AREA ZGQ'i0 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS /0.1 60 Sq.Ft.
INSTRUCTIONS TO APPLICANT /IUCLUb,NG m6>+AL sX16d
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 A"'D 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'
M M
i
N 1
I }
ec
to a d I
� r
9
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no charges will be made without
first obtaining approval.
�Jn�`
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) S G URE OF OWNER(S) OR AUTHOR ZED REPR SEN TA TIVE
60 NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHELTON PRTNTIN3