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Home My WebLink AboutBLD9287 Mobile Home - BLD Permit / Conditions - 5/10/1976 0 0 1-t w o C rt (C p m co CD rt �C w m ao m x - m � v El r° a. r- o m N u, ow x b rt m a" sr m w " a t%j I-h Pt En ur O �d o0w - rt !� m O H I-h rt F t-r n Qo O rt rt m ry F" N r N N In 00 I V V V _..--.---� -rrrur . G _2-� 7 J.1tid e BUILDING'PERMIT APPLICATION - � M MASON COUNTY P.O. Box 186 Shelton, Washington 98584 /- - 7 DATE ISSUED. _11 1-2C41 PERMIT NO. /gZS1 OWNER NAME MAIL ADDRESS 7� CITY a STATE ZIP PHONE C. t � 3 DIRECTIONS TO JOB SITE LEGAL DESCR. �/ %cj� $p� T ED EET) CONTRACTOR NAME MAIL ADDRESS CITY d STATE LICENSEE NO. PHONE USE OF BUILDING Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: b 131L. to s s a Valuation of work: $ d D PLAN CHECK FEE PERMIT FE d �d G� SPECIAL CONDITIONS: APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR I UANCE Type of Occupancy BY , Conat. Group Y Division 1f/�/ p r Size of Bldg. / No. of Max CONTRACTOR AFFIDAVIT (Total)Sq. Ft. Stories Occ. Load 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. 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 of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, which this permit is issued and that all work done will VENTILATING OR AIR CONDITIONING. conforfl�anca<therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED r IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS Owner SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER Date- WORK IS COMMENCED. PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH • BUILDING PERMIT APPLICATION MASON COUNTY ` DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 �� 427-9670 DATE ISSUED PERMIT NO. NAME MAIL ADDRESS .i CITY&STATE OWNER Q n ZIP PHONE l` / w 8s- /A - c DIRECTIONS ��tc.y� TO JOB SITE ! �, 0A ivea S i /4 OT PARCEL LEGAL NUMBER aA0190019 DESCR. CONTRACTOR pyo NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE USE OF BUILDING H0070 CLASS OF NEW WORK ADDITION ALTERATION REPAIR MOVE X REMOVE DESCRIBE �,yv►► /� p WORK ��1U� >'15� m0 Li, Ie /)O � ODV40 0� � l i 114 v BEDROOMS _! DECKS YOR CARPORT N NOTICE TOTAL SQ.FT. BATHROOMS DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR TOTAL SQ.FT. TOTAL SQ.FT. CONDITIONING. NO.OF STORIES �_ BASEMENT Y OFeND THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT. 4500 TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT gAW S FIREPLACE 4 0— ATTACHED SEASONAL -A.-1 / SHORELINE � DETACHED OWNERS FFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTR ION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND 1 AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUI ENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBT ING APPROVAL FROM THE BUILDING DEPARTMENT. q q APPROVAL FROM THE BUILDING DEPARTMENT. OWNER ��TE ate/ / X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED YES No YES No BUILDING VALUATION 1. HEALTH PUBLIC WORKS 21 FEE PLANNING I�I FIRE BUILDING PERMIT D.O.T. BUILDING Y` D PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE ?6010G S� _ 70 0 WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED -FOR ISSUANCE PERMIT VALIDATION co- BY�" CASH CK MO TOTAL _ /7 PLOT PLAN ADDRESS 6^ PERMIT NO. o s , io LEGAL 'Z LOT T lZ -In IP T aac�' .SO / l j f j jw DESCRIPTION �/C.� t` 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. U -1 X1D� INDICATE NORTH IN CIRCLE GRAPH SQUARES AR C15" R 1"-20' 10 I I. I w Alor t N 0 Vic 1 I/We certify that the proposed construction will conforrtt to the dlmensio►n and uses shown above and that no changes will be made without first obtaining approval. N AMEIfI F OWN Rl!) OR SITE ! fTR CTUREIf) (PRINT)TI IrN R F OWNER(S) OR AUTHORIZED 1WEPOPSENTATIVIE DO NOT WRITE BELOW THIS LINE APPROVE G DISTRICT AS NOTE d �^ �!�'/O DATE