HomeMy WebLinkAboutBLD21948 Final Mobile Home - BLD Permit / Conditions - 5/31/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 i
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS s CITY&STATE ZIP PHONE
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DIRECTIONS i
TO JOB SITE
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PARCEL LEGAL
NUMBER /iIGZ/7oT aDoO DESCR. �QS / W
NAME MAILADDRESS ITYfl
CONTRACTOR E LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES SEMENT 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. R PLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT ORELINE
SEASONAL
OWNERS AFFI VIT CONTRACTORS AFFIDAVIT
I CERTIFY THA I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTR TIO LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE WHICH IS PERMIT IS ISSUED AND TH ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONF ANC THER ITH. NO C NGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININ APPRO AL FRO HE M APPROVAL FROM THE BUILDING DEPARTMENT.
X OWN X BY DATE
i
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVENo DEPARTMENT YES NO
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANSCVfCKBY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY � CASH CK MO TOTAL
PLOT PLAN
ADDRESS ,4 r ���I'�I �lW�� /f IIYXIU PERMIT NO.
0
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LEGAL e
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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'
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I/We certify that the proposed construction will conform to the dimantioM and wes shown above and that no changes will be made without
first obtaining approval.
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7#11N W. Xag"Y
NAME(III) OF OWN[R(f) OF 31T[ 3TRUCTUREl3) (PRINT) I N OF OWNERIiI O4AUT. 1 R 3 N 1
DO NOT WRITE RE OW /S LINE
APPROVED ? P"
DISTRICT AS NOTED DATE JOL J O
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TYPE MOBILE HOME
Sq
Permit ND. 21948 No. Floorsg
Owner MugpHY, John Tel 644-1348 Date5-11-88 E,
Address 1717 - 159th SE #24 Seattle 275-4537ZiP sow
Contractor
Address ip
Iegal Description - -
Direction to PrO]eaE site
1 mile c ct of Allyn on Hens
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Fireplace Deck Garage Carport
Basement IOft Other
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