HomeMy WebLinkAboutBLD0247 Garage - BLD Application - 3/20/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED �!Q
PERMIT N0. �`
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d. �!NAME MAILADDRESS CITY BSTATE ZIP PHONE
OWNER ,�_
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DIRECTIONS .11911
TO JOB SITE fop
PARCEL LEGAL �'I3
NUMBER 13 'fa (3v/6n DESCR. :� � - / Zle /6
NAME MAILADDRESS CITY BSTATE VCENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK 36 A .
BEDROOMS DECKS CARPORT NOTICE
J/ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE 'l 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. IUd FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIMEAFTER WORK IS COMMENCED.
PERMANENT SHORELINE
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SEASONAL'
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
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I CT
ER THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIST ATION LA
W RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUI MENTS 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
INIWNE
FORMANCE THEREWIT . NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBING APPROVAL F M E BUI DI�lG DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
I ' DATE 2 -�y X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT Y APPROVE DO
DEPARTMENT YESPPROVENO BUILDING VALUATION
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HEALTH PUBLICWORKS FEE
PLANNING FIRE BUILDING PERMIT 8��c
D.O.T. BUILDING LL PLAN CHECK -C)0
SPECIAL CONDITIONS // BUILDING GROUP ` PRE-INSPECTION
wwwC �/ i/� .�/ ✓� rpv� fC SHORELINE
✓`c>, WOODSTOVE
PLUMBING
` cc) MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE I
APPLICATIU ACCEPTED BY PLANS CHECK BY A�PAOi(ED ISSUANCE PERMIT VALIDATION TOTAL /J
BY ' CASH CK MO
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PLOT PLAN
ADDRESS/% Q� /5G� 31 ,6,66 .1� L1/iti �b�'y� t� PERMIT NO. o
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LEGAL �' �� � 9Cf / r? j��/'✓. -S� ' '
DESCRIPTION LOT BLK ADDITION
SITE AREA C7 `^,` ,?� Sq. Fe. AREA OF SITE OCCUPIED BY BUILDINGS �,, 3 Q 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- S
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.
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INDICATE 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 dimensions and uses shown above and that no changes will be made without
first obtaining approval
NAME(!) OF OWNER(S) OF SVrE 3 STRUCTURE(!) (PRINT) ATURE OFWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELO TH �
IS LINE
APPROVED
DISTRICT AS NOTED DATE