HomeMy WebLinkAboutBLD9755 Mobile Home - BLD Application - 7/19/1976 D Z- , s
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED -/' 1q-Z.6
PERMIT NO. 97-5-J_
OWNER NAME MAIL ADDRES CITY&STATE Zip PHONE
�1
DIRECTIONS
TO JOB SITE
LEGAL �.�
(❑SEE ATTACHED SHEET)
DESCR. s' ` �� L !9
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR `q L� 7!�
USE OF C�
BUILDING ! 41/ -n f G
Class of work: XNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE d
SPECIAL CONDITIONS:
APP CATION ACCEPTED BY1 PLANS CHECK BY APPRODfED FOO ISSUANCE Type of Occupancy Division
B u'—Z Const. Group
A!'"
oF Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT. S
Firm PUBLIC WORKS
By ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner 4' ( �-lf Date lz 2, WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
✓ X
PLOT PLAN
THE,,HOUSE IS TO FACE DIRECTION INDICATED BY FRONT DOOR ON DRAWING BELOW.
p (INDICATE POWER, WATER, AND SEWER LOCATIONS)
W E
EK I-T(0
Mom
1633. 1
11 2-4s:1V
Dater -- � �
I (we) hereby approve the above drawn Plot Plan as correct and I (we)agree not to make any substantial changes in the
location of the house without written and advance notification to the contractor.
Purchasgrs: Evergreen H .
X By: X IF
X EMH-80