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Home My WebLink AboutBLD24479 Replace Mobile Home - BLD Application - 9/21/1989 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED`-' / /, PERMITNO��"7' 7 C OWNER AE MAILA R SS CITY&STATE P ONE i < G� DIRECTIONS Z TO JOB SITE PARCEL EGAL NUMBER t92q O� 1 0 DESCR. NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR USE f,/ Q BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE/'Y e WORK ✓ C�/l(/ DESCRIBE oaf / � WORK BEDROOMS DECKS CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS ZIP✓- TOTALSQ.FT.� � GARAGE CONDITIONING. NO.OF STORI ES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 SAYS, 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 OWNE AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGIST ATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUI MENTS 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 C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTA ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X NER DATE X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO i HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING cv/k PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATESURCHARGE , APPLICATION ACCEPTED BYj'M:rN_SCHECKBY_ APPROVED FOR ISSUANCE PERMIT VALIDATION BY /�{ CASH CK MO TOTAL /D �� PLOT PLAN ADDRESS ✓ �(/`r�,L _(,(/ � PERMIT NO. 4 0 = s w > � o LEGAL DESCRIPTION LOT BLK 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. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' IVV Owl 71 �i -C(. I/We certify that the proposed construction will oonform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. NAME(S) OF OWNER(SI OF SITE 6 STRUCTUREM (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE I MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (206) 427-9670 CORRECTION NOTICE Job Location / Z��L 2s�� This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be corrected to gain code compliance J==2.JDA)62 You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK Utia-ll for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to Department Date �� Inspector 7/7 WnT MnV 1 T A , INVESTIGATION REPORT FORM Revised 6/3/93 r) Part A: Nature of Complaint • Initiator's Name: Aid nti!4 ko O L( S • Address: • Telephone: • Owner Name: • Address: • Telephone: • Department of Concern ❑ Clerical ❑ Building ❑ Health ❑ Comm Development ❑ Fire • Area of Concern: ❑ Process Delay ❑ Personnel ❑ Policy/Fee ❑ Code Violation ❑ Other Refer to Director • Location of Concern: ' v, 5 P rC i a ot_ t��(y ►4rc � d% a R • Nature of Concern: -C r clw% it , rm I5 Part B: Concern Intake and Referral Received By: Referred To: Response Date: Name Date &J `\ Date Date Part C: Findings J Referral Forwarded to: ❑N/A / _ Name — Date Findings: //fie `72� t/5/ /,X/q/ll-;r— �iqS A M,gke /� Kl,2Qu,U,O �D ! j -57 its Part D: Resolution Name Date Intake/File Copy-White Referral Copy-Yellow Referral Copy-Pink Tracking Copy-Gold MASON COUNTY DEPART�of �P1fRAL SERVICES Courthouse N. Fovrth & WW. Cedar P.O. Box 186 Shelton, Washington 98584 (206) 427-9670 building environmental health maintenance landfill parks&recreation fair/convention center planning sewer&water September 1 , 1989 Judy Rickey SE 1344 Arcadia Road Shelton, Wa 98584 Re: Tract 2 of Wz of 3-20-28 Mobile Home Permit Ms . Rickey: The Environmental Health Division has been unable to locate records of the septic and drainfield system for the property. This will be very important relative to the approval of the mobiel home permit. We ask that you condiser finding some time to drop by the office so we can go through the files with you. You may be able to identify your records - especially if there have been several former property owners. We thank you for your cooperation. ENVIRONMENTAL HEALTH DIVISION /njp