HomeMy WebLinkAboutBLD0397 Double Garage - BLD Application - 5/20/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED 1 2 6�
PERMIT NO. n 3� l
OWNER
NAME MAIL ADDRESS CITY&STATE ZIP PHONE Z 7�1'-
- IF i
DIRECTIONS
TO JOB SITE �it/ � �
LEGAL
DESCR. T� o �v �E
o z76
NAME MAILADDRESS CITY&STATE kTCENSENO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING Z20 UP /r.' _ AAA)
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
5A el -_:�l X
BEDROO S DECKS CARPORT NOTICE
r SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
S BATHROOMS TOTAL SQ.FT. GARAGE' CONDITIONING.
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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 ATANYTIMEAFTER WORK IS COMMENCED.
PERMANENT SHORELINE lv r ��� 7 e>9
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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OW ATE Z' X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION pC>
YES NO YES NO
HEALTH $ PUBLIC WORKS FEE
PLANNING I r FIRE BUILDING PERMIT y
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP y/ PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE 5
APPL TI N ACCEPTED BY PLANS CH CK BY _ APPROVED FORUANCE PERMIT VALIDATION
��G -�'f BY CASH CK MO TOTAL 3 '� C
PLOT PLAN
ADDRESS PERMIT NO. o
n D
� O
LEGAL
DESCRIPTION LOT BLK ADDITION u
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 FOL ATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND E MENTS. UILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, F HCONTOURS OR DRA FIR5T OR ELEVATION, STREET ELEVA-
TION ARID SEWER SE E ELEVATION. SHOW LOCATION O WATER, EWER, GAS AND ELECTRICAL
SERVICE LINES.S LOCATION OF SURVEY PINS.SPECIFY THE USE OF EA H BUILDING AND MAJOR POR-
TION THEREOj
e_-:7� <' �' �`i Gz 7-
0 INDICATE NORTH IN CIR GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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f
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.
NAMEIS) OF OWNER(S) OF SITE a STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHELTON PRINTING
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