HomeMy WebLinkAboutBLD0106 Addition, Final - BLD Permit / Conditions - 5/30/1989 I,.
3iorelines: Plumbing:
ietback: Mechanical:
Special Interior:
;onditions: FINAL: Gas gg
Mobile cme:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Balls:
Framing:
Fireplace:
Food Stove:
TYPE ADDITION
?ermit No. 0106 No. Floors Sq Ftg 240
)saner EVERSON, Albert Tel 275-6944 Date 5-9-,qq
\ddress NE 2381 Old Belfair Hwy Belfair Zip
3ontract7or Self
'address Zip
regal Description Tr 3 SE,NE & SW.NW = $
)irection to project it se 2 miles North of Belfair on
Old Belfair Hwy. Little white house on left
um ing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
3asement ---loft Other
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED le
C
PERMIT NO.t�7 ll)G
NAM MAILADDRESS CITY SSTATE ZIP PHONE
OWNER l '
T c�a �F � v+ Q t 4
DIRECTIONS �'// / / /^ i�7 L r
TO JOB SITE /�/r/ h�s /YO 7-7'( (' Q`, �( �!1 D QI,C j ( ly
e W�"le bleo-'eF 0 77 A ep F7-
PARCEL LEGAL
NUMBER �� ODD`'3� DESCR. -3 O� S F /YE S W /lw S0 c' /
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. ZIP PHONE
CONTRACTORy
USE OF
BUILDING C%
CLASS OF NEW ADDITION )/ ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
CC 27 C )—e /Y F4
BEDROOMS DECKS CARPORTS C/ NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO. 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
OWNE SAFFIDAVIT CONTRACTORS AFFIDAVIT
I CER FY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIS RATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REO EMENTS 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 THERE ITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT NING APPROVAL FRO HE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
N� DAT �`! Z / 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 S
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHEC Y APPROVEq FOR I LANCE PERMIT VALIDATION
TOTAL L
BY CASH CK MO �/
PLOT PLAN
ADDRESS G- 3 (/.,(' C `l I `n/A PERMIT NO. s
� o
LEGAL
DESCRIPTION LOT BILK ADDITION
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT
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 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.
I DICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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,
I/We certify that the proposed construction will conform to the dinwnsidha and uses shown above and that no changes will be made without
first obtaining approval.
� 6P� � C, ,
NAMEW OF OWNER(31 OF 317E I STRUCTUREIi) (PRIN TI IGNA TORE OF OWNER(3) OR AUTHORIZED REP E3EN TA TIVE
DO NOT WRITE BELOW THIS LINE
.APPROVED
DISTRICT AS NOTED DATE
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S ► BUILDING INSPECTOR
5i1R1ECT T APPROVAL 1
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