HomeMy WebLinkAboutBLD N/A Move Storage Bldg - BLD Application - 5/27/1986 ' BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE_
DIRECTIONS // _
TO JOB SITE f1/r �R .� p `j. 0/} ou . '�o / A r
LEGAL
DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR N „4, S/ ('c) • 0&A to I( I' � CcJ/gS�i Jn SDS -,2 71
USE OF
BUILDING csji4
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE WORK REMOVE
✓
DESCRIBE �
WORK t k� t S /
(jcL/A ' rro4 � l / 04' W r /.� NP rJ.t
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PFRMI S REQUIREq G, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONI (f/
NO.OF STORIES BASEMENT ATTACHED THIS PE MES LL V IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMEN WITHIN 180\\\DA R IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. FIREPLACE DETACHED ABA ONE FORAPE 101VF1 0DAYSATANYTIMEAFTERWORKISCOMMENCED.
PERMANENT SHORELINE \//
SEASONAL
OWNERSAFFIDAVIT .,n, , C N R,RSAFFIDAVIT
a
CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF T E CON TS I THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON C UNTY ORD NCE WA INGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL W X(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 �THOUT FIRST CON FORMANJkTHEREWITH.NO CH GES SHALL BE MADE WITHOUT FIRST OBTAINING
L T B OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. �d1 APPROVA ILDING DE TMENT.
X OWNER DATE X BY 24c106—:i � DATE
FOR OFFICE USE " 0'
DEPARTMENT YES
PPROVEDJ0 DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
177
ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
IBY I CASH CK MO
PLOT PLAN
ADDRESS PERMIT NO. f o
= o
n D
p O
LEGAL
DESCRIPTION LOT 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 ARID 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'
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7
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A.
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.
NAME(S) OF OWNERl3/F SITE h STRUCTURE(S) (PRINT) I G N A^RE OF WN C 1 AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LIN
APPROVED
DISTRICT AS NOTED DATE
GHElTON PRINTINu