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HomeMy WebLinkAboutBLD12830 Mobile Home - BLD Application - 8/9/1982 * BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 p DATE ISSUED o 9-Fc;? PERMIT NO. / ;? d OWNER NAME `r MAIL ADDRESS ' `CITY& ATE c� \ W llip�G��� PHONE DIRECTIONS 1J10 TO JOB SITE ��� C 1" /'{ �� �Z ►q 3 1 K {.(, cl LEGAL T `- 1 l / 1` (❑ SEE ATTACHED SHEET) DESCR. 1 ha.LT-z ov C O V 4.c7 ` �/- �-3 S�a \� 7WA CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE USE OF '` Ic�1 `Q. �bV� E �W � W R BUILDING 1p eS 1 Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Valuation of work: $ S- -� d PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: BEDROOMS {DECKS CARPORT ❑ NOTICE BATHROOMS (TOTAL SO. FT. GARAGE ❑ NO. OF STORIES BASEMENT ElATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. TOTAL SQ. FT. FIREPLACE ElDETACHED ❑ 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 ANYTIME 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 conformance therewith. PERMANENT SHORELINES X Q SEASONAL ❑ FLOODPLAIN ❑ Firm E.D. NO. S.E.P.A. ❑ By a Special Approvals IN OUT YES APPROVED NO Lic. No. I`'H o Wffi 300 out Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. L/ 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 of the Mason County ordinance requirements for BUILDING DEPT. which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT Py / ICATION ACVPTE BY PLANS CHECK BY I A64ROVED FOR 16SUANCE Date- VIPv i ', ,HECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION UCK. I M.O. CASH • PLOT PLAN ADDRESS 1 , UJA( v �� /C r/ PERMIT NO.LEGAL o s o / r v DESCRIPTION LOT v� COVhot BLK 2 ADDITION( -2.0 R ' -3 u SITE AREA L 3 ©Q Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS A10 Sq.Ft. m INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN t"-20' ARE C FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) a FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF 7 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"'D 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. O W INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' c/ Sl cc LrI ac f o [/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. CAW6lA 0 Qa'12 NAM (S) OFIOW R(a) OF SITE 6 STR�TU (PRINT) SIGNATURE .,OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE iH6LTON PRINTING > Y � L a1°i c 1• a� c� c ; D a i cn g m m o w N a, X m Z ~ E L10 N N d C W E .m O > O ? D U m V J O ` I Z C C N > 7 > I= l 00 �p N � Q = e m a E �° a m t y LL 9 .� „ o > w a ar 1 " cn O E w cUv Q o m o �+ a w (� n Y Mn L Y N ~ 1 o g C� co v o �a a, Y O p r c) c) cn X m a Q m m a. LL Q F- a b t) tL da WE 4Y I J U O C7 Z f J c _ a, w c L uj 3 —y Y O n U w d •- i v N m Z Z' m -1 o N m o Q o f�0 fT0 I LL m m - o a. a LL U) S 0 U m Z a LL U - !i I� Y ` JO L 7 F- cn 0 . wm b0 m Z m W Q 1O m cn - a a, o ?� Q C L F�• > a N U U C fll J c 3 0 = 3 w $ a o` o d Fx- > x a`)i 0 O a in o C7 3 Q = cn ii a w 2 w W o w m O a- -- 7 > > J J Q Z 3 oa O Y c io > °� a no E G Z V Y w m C Y U a V o 0 M = o o X N t = o 0 'c U L`i Ow U a w U to to U > m w u. 2 0 to � � Z W h i N Q ~ E O X a W C W Z { �I 4: O 112 C N o w a 0_ LL v� y C a a A _0 � >C Z o o 3 Oa moo Nro 12 a w In M o0oa ° aa e 71 i I 1 y ; I : 111 71