HomeMy WebLinkAboutBLD15901 Move Mobile Home - BLD Application - 7/26/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 .7
DATEISSUED
PERMIT NO.
OWNER NAME - MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS / . _ , _ 4,445oni LA.-Q
TO JOB SITE /V/�f /� ��i�J �/l/l G'rG� ��C�/ �'�'%� O/U /G a� J�% �oN Cj/<'Al/oL�A,i
LEGAL I / _ n ([I SEE ATTACHED SHEET)
DESCR. �� `o / c /'��T'44L) GU5.
NAM MAIL ADDRE S ITY..&STATE LICENSE NO. PHONE
CONTRACTOR ] /
'r�Jf'r1Z'1� 7����
USE OF _
BUILDING ��
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
Valuation of work: $ CHECK FEE PERMIT FEE
c
SPECIAL CONDITIONS:
BEDROOMS _ {DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SQ. FT. 1 GARAGE []
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT.,#90 FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor In WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the" permit is issued and all work done will be in
cpnformance therewith. PERMANENT _ SHORELINES
SEASONAL[ FLOODPLAIN
Firm E.D. NO. S.E.P.A. [_1
By Special Approvals IN OUT YES APPROVED NO
Li N& Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is ' ued and that all work done will ROAD ACCESS
be In co Prma a th rewith. MOTOR VEHICLE PERMIT
APPLICATI ACCEPTED BYo PLANS CHECK BY APPRQVP FOR ISSUANCE
Date . � Je
el BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. o
LEGAL `� A
DESCRIPTION LOT „[ BLK ADDITION u
SITE AREA Tnt00 Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS 11g0 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 P"ID 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 SQUARE ARE 5' X 5' R 1"=20'
I/We certify that the proposed construction will conform to the dimensions and uses shown above an hat no changes will be made without
first obtaining approval.
SGr�oN fR lS��
NAME(S) OF OWNER(S) OF SI E & STRUCTURE(S) (PRINT) _STGN U E OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW TH LINE
APPROVED DATE
DISTRICT AS NOTED
SHELTON PRINTING