HomeMy WebLinkAboutBLD0485 Change of Use - BLD Permit / Conditions - 1/20/1987 TYPE CHANGE OF USE
( Permit No. n489 No. Floors 1 Sq Ftg 480
( Owner EPPERLY, Frank D. Tel 876-6172 Date 1-20-87
Address P 0 Box 5234 Belfair Zip
( Contractor Self
Address Zip
( Legal Description Tr 15 N-1/2 10-23-2
Direction to project site Bear Creek - Dewatto Rd.
7 miles to Blacksmith Lake
NE 540 Blacksmith Drive
Plunbing _XMechanical Sewer Itbod Stove g
Fireplace Deck Garage Carport
Basement Loft Other
1 bdrm
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
MobileHome:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO. C? 41
OWNER MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS I
TO JOB SITE � e ck-c c f f e W\, ar, ,; , /ter
LEGAL
DESCR. JF I C7 I V _d
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING O -'se-
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK 10 a O V rA
BEDROOMS__ DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS_ _ TOTAL SQ.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 SO.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
I CERTIFY TH T I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATIO LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREME S 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 CONFOR ANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING PPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER TE I X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION e'e'
. OSO•
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
/ram
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS C ECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
iy.vt� BY CASH CK MO TOTAL �Q, eel
�- 5
i
PLOT PLAN
ADDRESS �� �L'+ 1 qC_ PERMIT NO f o
z a
n s
a o
LEGAL
DESCRIPTION `J LOT } N )I O _ 3BLK ADDITION
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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
J
I/We certify that the proposed construction will conform to the dimensidrts and uses shown above and that no changes will be made without
first obtaining approval.
1� 'C « vl�li4 Y'_ Q ��
NAME(3) OF OWNER( OF SITE tr STRUC TU REM PR NT) IGNATURE OF OWNER(S) OR A HORIZED R P ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE