HomeMy WebLinkAboutBLD22464 Dock - BLD Application - 8/5/1988 BUILDING PERMIT APPLICATION
Q MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED - �—
PERMIT NO. �
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER 0 v se'Al v4 � � � r 4L 1- r'c.Cc'r Lc�2
DIRECTIONS To- mtv6ev LK, ✓' iix7y.
TO JOB SITE =,� T11'/ S c o ,f c,
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PARCEL LEGAL1
NUMBER a � 454 (3d(i� DESCR. 'n - 5 rah $ e,R dll,c IlA y
NAME MAIL DDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR << _ y , p0a
USE OF
BUILDING (j�K
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.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
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
OBTAINJER G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OW DATE X BY— DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT YES No
BUILDING VALUATION L N�
YES NO
HEALTH �!� PUBLICWORKS FEE
PLANNING FIRE BUILDING PERMIT �`S✓L)
D.O.T. BUILDING (,�� PLAN CHECK ` S
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION ,
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS,CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL r
BY G4//C CASH CK MO
PLOT PLAN
ADDRESS Masco L i G ! PERMIT NO. _ y 8
w s
a o
a
LEGAL ^
DESCRIPTION LOT �� BLK ADDITION , , ;ij& y 'jrunn 4 0.
tiH4R It Ccdd i .rrl Cr
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.
I i ,
CL
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
� y
iq
- ISp iT
or
I/We certify that the proposed construction will conform to the dimensidns and uses shown above and that no changes will be made without
first obtaining approval.
Al (L� / � ,r5 WekNee Jo n nSo j
NAME(a) OF OWNERM OR aITE STRUCTURE(!) (PRINT) ONATURE OF OWNER(e) OR AUTHORIZED P ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Courthouse Annex 2 N. Fourth & W. Cedar
P.O. Box 186 Shelton, Washington 98584
(206) 426-5593
building environmental health maintenance parks&recreation planning sewer&water
August 1, 1988
Werner Johnson - -`
129 Cornell St.
Tacoma, Washington 98466
Re: Building Permit for Dock
Dear Mr. Johnson:
Some time ago you made application through this office to
obtain a building permit. Please be advised the permit is
ready to be issued and can be called for at this time.
If you are unable to call in person, a check in the amount
of $ 61.25 can be sent to us and we will return your
permit by mail.
This permit becomes null and void if not called for within
180 days of the date of application.
We hope to hear from you soon.
Sincerely,
Evelyn Fuller
Receptionist
Djt4v� J1
H U U �t 1988
.;E;*N" AL SERVICES