HomeMy WebLinkAboutPre-Inspection - MIS Application - 10/9/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
2/Y,o G,07 426 W CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
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A-TRf-R Tit�9/N6 P)j kT VA/T/V 1-LCvj 427 9670 DATE ISSUED
� 1 PERMIT NO.
NAM J
r� MAIL ADDRESS/� CITY&STAT ZIP PHONE
OWNER CS �/��LUI` Zc�Z /Ju �sl �13v ruG 76
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G(J4 :3734' 7¢
DIRECTIONS �^ _ n / _ _ d�,
TO JOB SITE r II+�A`a)A � /✓A1,t f 1�7 I� l l,C--2 , /�! AT /` V� T(�
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PARCEL
NUMBER Lio-7 � t V+ L � r ! &/z
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTORUSEOF
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BUILDING �� �,� S>1✓ 1 t"jJl�f/�
CLASS OF WORK NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE _ _
WORK n C ill- �r��tG /�J �� 5 /C' 1/�Jf) IAA
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CAN -f-- l? 7- / t/(U/ Pr p6iF 1 .6 FIT o v 4/2.iw 9 4c pkz-A o
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE 1IZt�)SgFt STORIES SHORELINE CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS SqFl BATHROOMS I SEASONAL RES.O COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED ETACHED❑
OWNERS AFFIDAVIT 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 1 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 OWNER n0 DATE 'v l ` X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YES NO
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS^,5/p BUILDING GROUP PRE-INSPECTION L)
!6 41 R£ �9o%,D -,07 //y/s %/Yl� �WdU/.pN/ �E Od N SHORELINE
IkPof/$ O/Z ;%4A, % r/SXFQ 4111tf P IDA C'D 714 Vorl t,41 WOODSTOVE
PLUMBING
5 A S,/lUG////Z J /i G K 47 /� '/A'L MECHANICAL
DULL 5MkgFDdv% 0# D '/g-Pl f��/° S%/lvGt�V/I. STATE BUILDING FEE
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APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
C TOTAL a
BY CASH CK MO � : O 6
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAILA00RESS1 ATE �� pp ZIPS) PRONE
OWNER �IU J IA t >� 4-oz Q IRL&o A-exD F £. TON Uli� b 'JI - c47
DIRECTIONS I 0,1 r -t
TO Joe SITE I PA ki'm I�kl V ��} t(� a N N Hil 10 ZM�E j
4,EP-r p6 LAt25o/u 4ty412A TL2, ZjVd g2r I;T-UN P-i 6#7(41 G A L4L4 VJA Li - z J 47- nn To e LEP7
PARCEL LEGAL '
NUMBER I OESCR. I bo IT CL`A
Indicate below: O Property lines and dimensions.
O Easements and roads. •
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building & septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system "as built"or septic permit-approval.
O Indicate topography profile of property and structure on reverse side.
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I/We Certify;hat the Pr000sed construction wil!conform to the dimensions and uses shown above and that no charges•Mill be made without first Obtaining approval.
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SIGva hE 0=OwNERi OR AUTHORIZE) RE?RE3=.yTA NVE
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TOPOGRAPHY PROFILE OF PROPER TY AND LOCATION OF7TRUCTURE
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