HomeMy WebLinkAboutBLD19343 - BLD Permit / Conditions - 9/22/1986 TYPE GE STS E
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
PO BOX 186 SHELTON, WASHINGTON 98584 u
426.5593 DATE ISSUED
PERMIT NOL.
NAME MAIL At5LIRESS C€TY&STATE ZIP PHONE
OWNER
L IRE TIONs
TtiJS SIDE D .. '
LEGAL
ES H. ADD O14 J1
NAME MAdL DDRE S O TV&STA T° L6 ENSE NO. SIP PHONE.
USE OF
BUILD BUiLD N
CLASS S NEW ADDITION 11 ALTERATION HAIR ► O E REMOVE
WORK -
DESCRIBE
WORK
BEDROOMS OMS _ DECK' CARPORT
SEPARATE PERMITS ARE REQUIRED FOR PL MIT NG, SEATING,VENTILATING OR AIR
BATHROOMS TOTAL.S ,FT. 1 ARAGE CC NDITIONING
NO,OF STORIES BASEMENT , m__ ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 160 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO FT FIREPLACE _ DETACHED ABANDONED FORAPERIOD OF180DAYSATANY `IME AFTER WORKISCOMMENCED.
PE MA E. T SHORELINE
OWN RS AFFIDAVIT CONTRACTOP S AFFIDAVIT
ICEIJIPY THAT I AM EM FROM THE REOUIREMENTS O, F TIk CONTRACTORS I CE TIP THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OP
REGIrRATION LAW RCW 18.27,AND AM AWARE OF THE MA ON COUNTY ORTIINANCE WASHINGTON IN I AM AWARE OF THE ORDINANCE R QU1REMENTS REGULATING THE
REO IREMENTS FOR WHICI THIS PERMIT IS I ,SUED AND THAT ALL,WOR NE WILL BE WORK FOR WHIG H PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN IONPORMANCE :THEREWITH. NO CHANGES SHALL BE MADE WII OUT FIRST CONFORMANCE EREW-H.NO CHANGES SHALL BE MADE WITHOUT IN ST OBTAINING
OB1JINING APPROVAL FROM THE BUILDING DEPARTMENT APPROVAL FR THE ILDING
,bWh E 1 DATE X E DATE
DEPARTMENT T AP OVED DEPARTMENT APPROVED BUILDING VALUATION YES NCI YES NO C
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDINGPERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUBUILDING GROUP DREW INSPECTION
IO
CL .`." ,iii SHORELINE
PLANNING
PLUMBING
MECHANICAL
ANICAL
STATE BUILDING FEE
STATE SURCHARGE
API.ICAT`dCTIV ACCEf�TEk SY FLANS ITY APRROVE FOF3 I ANTE PERMIT VAL#CTATlt5AY
s P Asti "'
PLOT PLAN
AP4E P`EP1d�11"T NC}, � �,
R D
5flO/ LC /fl g
LEGAL 1
C SCRIPTION LIST SLK`, A ?CIT ON
SITE A , Sq.Ft. AREA OF SITE IED BY BUILDINGS _ Sq.Ft.
INSTRUCTIONS TO APPUCANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS A TO SCALE OF NOT LESS THAN 1 ' APE
FILED WITH PERMIT APPLICATION, (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.
FOR NEW BUILDINO8 PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SItNS,SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE,.FIRST FLOOR ELEVATION, STREET ELEVA«
T1ON "'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY P!NS SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF;
INDICATE NORTH (N IN CIRCLE GRAPH SQUARES ARE ' X 5' OR 1"- '
: : xt:1:I:L . xxxb't_ x xxx :
m e �
_ a _ = = -*
L
t
I/W if that tfta tit II tt a will a without
f1Obtaining approvaI.
t t 3 F WPa t 4 t t tJ ttd {fit t t 9 1 N V WN t tt H t O . tY
No RfT EE A{AS L i E,
APPROVED
DISTRICT AS NOTED DATE