HomeMy WebLinkAboutBLD18899 Addition - BLD Permit / Conditions - 7/1/1986 TYPE ADDITION
Permit No. 18899 No. Floors Sq Ftg 288
Owner HOWF.T.T, C:a 1 Te1275-4052 Date
7-1-86
Address NE 90 M . View Place Tahuva Zip
Contractor None
Address Zip
Legal Description Collins Lake Div, 3, Lot 60
Direction to project site
Plunbing Mechanical Seer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
I- 12x24 Porch
Shorelines:
Setback: He'hhaann
Special Interior:
Conditions: FILL:
Mobile Home:
Smoke Detector
Remarks• c
Footing: o a
Setback: '
Foundation
Walls:
Framing: %p 7" k1b ERMIT
Fireplace: Litt L & VOID BY EX A
Wood Stove: - *+�
y BUILDING PERMIT APPLICATION
�j MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED / f
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE�IS„tT) .�
OWNERCARL- � L_ 8 ,-,< ZZ4 i S
DIRECTIONS 1
TO JOB SITE AREA
LEGAL
DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF /
BUILDINGCLASS
►� , �} �!(� /���
WORK O✓ NEW L--, ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK YY7
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 At
SEASONAL
OWNERSAFFIDAVIT 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� � G� DATE ../ - XBY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED BUILDING VALUATION
DEPARTMENT DEPARTMENT
YES NO YES NO
HEALTH J' PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT '7 7
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP r _ PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY L
LA S C ECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
T) BY CASH CK MO TOTAL /. �
PLOT PLAN
ADDRESS M I tilt L L 724 N i1,,4 A PERMIT NO.
a 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 A'"D 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'
i
I
i I
c..
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 OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) tIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING