HomeMy WebLinkAboutBLD14228 Mobile Home - BLD Permit / Conditions - 6/23/1983 +'V
bqv BUILDING PERMIT APPLICATION
MASON COUNTY
1- P.O. Box 186 Shelton, Washington 98584
426-5593 _
DATE ISSUED 0
PERMIT NO. -.0 S3
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NAM M IL ADDRESS // CITY TAT pZIP [1 PHONE
OWNER �� �7Z/ G.. C f$. IS
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DIRECTIONS 0 ( or 1 _ �1 od/�
TO JOB SITEC�.rX
LEGAL � ) r (❑ EE ATTACHED SHEET) ) y
DESCR. 1v *F 1 V O �lJ CJ SE f.f , anJ l/1.�.�tJ•�.
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LIC NSE NO. PHONE
USE OF
BUILDING Horn
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: u
J �
Valuation ofCwork: $ �, I� PLAN CHECK FEE PERMIT FEE
04. (�
SPECIAL CONDITIONS:
P 21
C Ile,A/-7 tw—l%
BEDROOMS ��� I DECKS CARPORT ❑ NOTICE
BATHROOMS / I TOTAL SQ. FT. GARAGE [7
ATTACHED f SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. 0
1W FIREPLACE I DETACHED L7
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL [] FLOODPLAIN f]
Firm
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT EALTH DEPT k3 p
WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance Threvvit� MOTOR VEHICLE PERMIT
/ PLICATION AC TED BY PLANS CHECK BY APPROVED OR ISSUANCE
Owner Date. r� 3 y
P CHECK VALIDATION CK. M.O. CASH PER IT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. 0 o
n D
D O
O
LEGAL a
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 P"'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'
0
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.
4A. b4l OWNER(S) OF S1TE Q STRUCTURE(S) (PRINT) A R OF WNER(SI OXAUO IZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING