HomeMy WebLinkAboutBLD25511 Repairs - BLD Permit / Conditions - 4/20/1990 Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE REPAIRS
Permit No. 25511
No. Floors Sq Ftg
Owner HENNINGSEN, Pat Te1275-2089 Date 4-20-90
Address P 0 Box 205 Belfair Zip
Contractor Self
Address Zip
Legal Description Tr 4 NW,SE 29-23-1
Direction to project site 5th driveway on' ri.ght after
corner at brick bldg. Hwy 300 SEE ROB HE ,KNOWS RIGHT
_WHO THIS IS. . .
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
PERMIT N0. rh%r
E MAILADDRESS CITY BSTATE - ZIP PHONE
OWNER �p-pi t4 ! K C s e Pa B 7.5=J�Off
DIRECTIONS
TO JOB SITE %�� \� f U(i!-_PARCEL C04CI LEGAL
NUMBER 17�3r� ?� DESCR. fil F
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR S
USE OF
BUILDING � L C o
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK1
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
TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
ill
,
OWNERS AFFIDAVIT 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
REGI 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 THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OB ININ OVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
W -DATE D �7 X BY DATE
FOR OFFICE USE ONLY
APPROVED NT APPROVED BUILDING VALUATION
DEPARTMENT DEPARTME
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE / v
STATESURCHARGE
LIGATION ACC TED BY PLANS CHECK BY 1'�BPY
PROVED FO ISSUANCE PERMIT VA TION
CASH CK MO TOTAL
PLOT PLAN
ADDRESS ll�.� `f� lC % _j O() PERMIT NO. 0 o
— — -
w s
°o
LEGAL
DESCRIPTION LOT BLK ADDITION a
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"a20' 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.
0 INDICATE NORTH IN CIRCLE G Rnou 2011
�' 11
Ff
I
I
-1
I
o c
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.
NAME(e) OF OWNER(a) OF SITE ! STRUCTURE(!) (PRINT) SIGNATURE OF OWNERM OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE