HomeMy WebLinkAboutBLD0055 Carport - BLD Application - 11/15/1988 ��v� BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
-0 4 C160 6 PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS //ll IC L OXB7.2
TO JOB SITE z)"4, 0 i 8 C y G
'VE
LEGAL //`` �/� J�
DESCR. Si9m C%!�� '(.'.ARoe-J / ACTS �' T J/ /QRCT
CONTRACTOR NAME MAIL ADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK _GLr 0
RECORDS OF SEPT C INSTALLATION NOT LOCATED-WILL NOT AFFECT THIS PROJECT-MAY
AFFECT RE-FINANCING OR SALE OF THE PROPERTY
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
SEASONAL
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
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
REQ REMENTS 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 INING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
qw-
N E ItM 4'�"A T!( , - � X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION / C C
YES NO YES NO / . ���(�
HEALTH _4 PUBLIC WORKS FEE
PLANNING �� FIRE BUILDING PERMIT j S
D.O.T. BUILDING / PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP �'_ PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATIONACCEPTEDBY PLANSC/HI�/KBY APPROVED FOR I UANCE PERMIT 7VALICDAITION
-�t�=• r/ BY�� CASHK MO TOTAL
i
PLOT PLAN
ADDRESS .3e %,O /7 /!LC''i �C'/'/�/a8 PERMIT NO. 4 8
JS4 e /e r S 0»1 e r r4 /V'0' * 7/t we i-S o
0
LEGAL
DESCRIPTION LOT ^7 le. /,S' 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 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
S ,C 7
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.
A' � "
N AME(31 OF'OWN ER(3) OF E • 3T RUCTUREl3) (PRINT) IGNATURE OF OWNER(S R AUTHORIZED REP ENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE