HomeMy WebLinkAboutBLD28387 Mobile Home Space 44 - BLD Application - 7/10/1991 nor
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED D ��
PERMIT NO.
OWNER ME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS ✓ ���� ell
JOB SITE
PARCEL LEGAL 7 NUMBER 2220,50, DESCR. A�LL1r'/v BL.K r l IF8 L-OT - 10
CONTRACTOR NAME I MAIL ADDRESS CITY&STATE ZIP PHONE LICBM NO.
USE OF
BUILDING d e-v
CLASS OF WORK NEW ADDITION ALTERATION �IEPAIR MOVE REMOVE
DESCR
WORK IBE 'fi
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE O CONDITIONING.
BASEMENT SgFt BEDROOMS _� PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS SgFt BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED O DETACHED O
OWNERS AFFIDAVIT 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.
XWWNER Ukr' (' ��
DATE J l�i X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVEDAPPROVED
DEPARTMENT YES
YES NO O BUILDING VALUATION J
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
S L SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY APP E R I CIE PERMIT VALIDATION
BY CASH CK MO TOTAL
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAM ADDRESS CITYATE ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE
PARCEL LEGAL
NUMBER I OESCR.
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building&septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands,drainage.
In Circle O Attach copy of septic system"as built' or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
tj CA L&I ad
70
O
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.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE