HomeMy WebLinkAboutBLD30034 Addition - BLD Application - 6/6/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUE
PERMIT NO.�
NAME Al ADORES CITY&STATE ZIP PHONE L�/'3 7
OWNER L L C" N Ct'7 (34L c-L
DIRECTIONS Ifn
TO JOB SITE b— >PARCEL C IC
NUMBER 3c�1�7 5 tpl i DESCR.
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE / ZIP PHONE LICENSE NO.
�V�� j.�'X / s /fie`- �7�0 '�
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE I 1
WORK L/ / �d 1y0
DA) oS 6& 4N+ 4DO t4- I o ,J - �'+Al 'lh/
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE'ao-_SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED O
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 I 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.
XOWNER DATE _ _ XBY �9 � , DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT vesPPRovENQ BUILDING VALUATION
HEALTH �� PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT J
D.O.T. BUILDINGS PLAN CHECK
SPECIAL CONDITIONS BUILDINGGR OUP �. Zi';�� PRE-INSPECTION
W /r�C✓ l t M _,e SHORELINE
S -r (� :m WOODSTOVE
PLUMBING
MECHANICAL
C STATE BUILDING FEE /+ Sv
ICATION A CEPTED BY PLANS CHECK BY APPR D R ISS CE PERMIT VALIDATION J
TOTAL
C CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
--ow In Ik Ito 427-9670 DATE ISSUED
S gc4l oN a ? PERMIT NO.
NAME MAIL ACORi SS CITY d STATE ZIP PHONE
OWNER 5A&
_
DIRECTIONS
ro Boa SITE 1 g l n 6 CL.
I
PARCEL LEGAL j
NUMBER DESCA. L ��� / ' �/ L7 t J !U U
Indicate below: O Property lines and dimensions. JA U
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.
In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage. _
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/�'!@ ceRify:ha:tnt p QJi2'QQr.s: uc:iCn w" Qn!Jfm tQ 'ir7@^SIGHS and uses s`Jwn above and:hat no changes will b@ n$C2 wit`Jut ii($;Jt]f3inins aapNval.
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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