HomeMy WebLinkAboutBLD0255 Carport - BLD Application - 4/10/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATEISSUED � AF
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER 4 -D . - 24,
DIRECTIONS /� / �` p °� ��e
TO JOB SITE �i I �- yr � c a � � �.� � cr �.-/ r-,
0 ��+.� v o ` v , _ 5 4-, e //P-- a vJ v-e a �dztcvs 7L� /jvu
PARCEL LEGAL
NUMBER 0-3Z -o031v IDESCR.
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CONTRACTOR _NAME MAILADDRESS CITY&STATE YTeEtiSE-Her ZIP PHONE
ll�'e W T c - ,a I i - S^'e
USE OF Ga---c- PC) r
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK P.
DESCRIBE --) 6/X Z G ,,� o� G
WORK Fla le- f a v "� - s k D d
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BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.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
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE l �
SEASONAL 0 c-0-77cG
69-
OWNERSAFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIST TION LAW ROW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR 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
IN CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN G APPROVAL FROM THE BUILDING DEPARTMENT. APPR L FROM THE BUILDING�DEPARTM T.
XkW ER DATE X B DATE / v
FOR OFFICE USE O
DEPARTMENT YES
SPPROVENo DEPARTMENT YES NoBUILDING VALUATION Q (0
HEALTH PUBLIC WORKS FEE
PLANNING ; FIRE BUILDING PERMIT
D.O.T. I BUILDING PLAN CHECK 2
SPECIAL CONDITIONS BUILDINGGROUP - PRE-INSPECTION
Ak37-E--. All rnJGr !1'1'' SHORELINE
v --� C A I WOODSTOVE
5-pi ;isl T PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE '
APPLICATION ACCEPTED BY I PLANS CHECK BY-4L!GD ARA99VEQ FaMPSUANCE PERMIT VALIDATION
1-20— O IBY CASH CK MO TOTAL <9 u a
PLOT PLAN
ADDRESS (J (�//Lrrf /f L`1 ,I {�e �J �__. PERMIT NO.
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0
LEGAL
DESCRIPTION LOT BLK ADDITION
vV
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. P' Q
� G
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I/We certify that the proposed construction will conform to the dlrmnsions and uses shown above and that no changes will be made without
first obtaining approval.
N AME(f)•OR OWNER(S) OF SITE i lT RUCTUREI!) (PRINT) I NA TU OF OWNERI! N RI ED REP EN TA TIVE
DO NOT WRITE BELOW LI
APPROVED
DISTRICT AS NOTED DATE