HomeMy WebLinkAboutBLD27187 Final Mobile Home - BLD Permit / Conditions - 12/23/2004 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. �� U
OWNER NAME MAIL ADDRESS r CITY&STATE ZIP PHONE
6 - 33
DIRECTIONS
TO JOB SITE
PARCEL FD
AL
NUMBER ���30- �W 0 6uCR. V� � �� / cSe C Q
E MAILADDRESS CITI&STATE LICEWSENO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION : ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE -
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT 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 SO.FT. FIREPLACE DETACHED ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSA FIDAVIT CONTRACTORS AFFIDAVIT l
I CERTIFY AT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
CERTIFY
LAW RCW 1&27,AND AM AWARE OF THE MASON'COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREM TS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WQRK FOR WHICH THE PERMIT IS ISSUED AND-ALL WORK DONE WILL BE IN
IN CON MANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINI APPROVAL F M THE SUILDI DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X O ER ATE — X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED /
DEPARTMENT YES No DEPARTMENT YES NO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONt M( NS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLI TION ACCEPTED BY PLANS CHECK BYE�^^ VE ISSUANCE PERMIT VALIDATION /J
Q
—(y BY CASH CK MO TOTAL ,/�
•
♦ ITIAIL ADDRESSae •
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DIRECTIONS
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NUMBER
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Shorelines: Pluflbing:
Setback: Mechanics :
Special Interior:
Conditions: FINAL: — j
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Mobile—none: ,
Smoke Detector';
Remarks:
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TYPE MOBILE HOME
P*Wt No. 27167 — No. Floors __ Sq Ftg 1344
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