HomeMy WebLinkAboutBLD N/A Garage - BLD Application - 2/28/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
AME MAILADDRESS CITY&STATE ZIP PHONE
OWNER eg
S, W Z glpx 13 7 5 o w-I catnvT AL. 55 bob Zy5-525
DIRECTIONS I TO JOB SITE 5 E, ZXil fj MAscm LY,. DV. E .[]� I�1'T/� Ep --
PARCEL LEGAL
NUMBER z22335Z0007a DESCR. MADIIJ% SUNN Sftp(Lt #1 - TR.:-710
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR f c)PjEQT g0WQ a: , 2 (3ox 117 5UL.Uc,ENr AL. ;3S5g U6oi zys-s-Ls
USE OF n ,�
BUILDING C-1 A(ZAc�E
CLASS OF NEW X ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ T� (1
WORKDESCRIBE 0VtL R)I)NDA7000 4t%6 e 'A �y' 3o C-A C L �VI
() 1,3 FyA G(zvaN o o N MASo rJ Lk- PjZZp&znj Ajpp&n-X 2-(,0'
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BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE X 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 ANYTIME 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
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.
X OWNER DATE �tA�. o. �Q q� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK SY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO
1
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SH ELTON, WASH I NGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER e- Z Bor, 137 Sow L. 3SST �01 2`t5 �D
DIRECTIONS
TO JOB SITE ScS ATr;�cjjz rn ._ I 1 M ASO rJ Lk- , C)Q
PARCEL LEGAL
NUMBER 0 DESCR. M AO)NGS 5 V NN 5 Hea-E -It-6 TQ . -7 0
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.
In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage.
O Attach copy of septic system"as built' or septic permit approval.
O Indicatp topography profile of property and structure on reverse side.
OS
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I/We certify that the propose o t on will conform to the dimensions ai d uses shown above and that no changes will be made without first obtaining approval.
6 L5�74-�
SIGNATURE OF OWNER(S)OR AUTHORIZED REPPtSENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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