HomeMy WebLinkAboutBLD15676 Final Carport - BLD Permit / Conditions - 7/2/1984 BURDICK, John G. - #15676
6-14-84
Lake Limerick, Div. 4, Lot 116
22023 llth Ave So.
Des Moines, Wash 98188 824-3383
At entrance to Lake Limerick, turn right at Fire
Station to Bollbrigan Rd. , go left 3 blocks, sign on
property.
Contractor
None listed
Carport
$2,000.00
Shorelines•
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical •
Roof
Exterior •
In ter ior•
Final � c-
Stop Work:
Mobile Home:
Smoke Detector•
Remarks•
•.r
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �Y,/��
PERMIT NO.
OWNER NAME ` MAIL ADDRESS CITY&STATE ZIP
a �/ 2 l � + C
DIRECTIONS 6Z j-jQctAt '*e) L 1-71[ •ejQ l-t ( C, /ELv `o_ s�Y
TO JOB SITE L� GGs C L k—T 3 13/ IC 'rr'—
LEGAL / // / / (❑ SEE ATTACHED EET)
DESCR. L d l it D L� LQ I e L 2 e �C'
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING C�
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
G•—
Valuation of work: $ I ��� PLAN CHECK FEE PERMIT FEE j
SPECIAL CONDITIONS: `
6
BEDROOMS I DECKS CARPORT NOTICE
BATHROOMS TOTAL SO. FT. GARAGE L;
ATTACHED `,__ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I am aware of the FOR OFFICE USE ONLY
ordina ce requirements regulating the work for which
the p rmit is i the
and all work done will be in
co rmance therewith. PERMANENT ❑ SHORELINES I
SEASONAL I i FLOODPLAIN 1_1
Firm
E.D. NO. S.E.P.A. L i
By Special Approvals IN OUT YES APPROVED NO
Lic. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
oic
permit is i ed and that all work done will RO ESS
formanc erewith. MOTOR VEHICLE PERMIT
=CATIONCCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. B
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
--�-- PLOT PLAN
ADDRESS 2 ' Z ��'Z L' S( t 1 c /J{'� c PERMIT NO. f o
LEGAL LJ/ A D
DESCRIPTION LOT B L K !�l L ADDITION Z_C��f�=
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 A"ID 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,
(3 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
l
d
�L <
i
1
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes wm be-- e without
first obtaining approval.
NAME(S) OF OWN ER(31 OF SITE EI STRUCTURE(S) (PRINT) i A OF OWNE (51 O AU TH I REPRESENTA VE
DO NOT WRITE SELO /S LINE
APPROVE G� DATE
DISTRICT AS NOTED
SHELTON PRINTING