HomeMy WebLinkAboutBLD25037 Mobile Home - BLD Application - 1/16/1990 U LDING PERMIT APPLICATION
MASON C OUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED �- -
per' PERMIT NO.�2l' X l
NAME CITY&STAT �^—
OWNER l M ADDR S E, ZIP PHONE
C�. -
DIRECTIONS
TO JOB SITE
z ePARCEL
'�
NUMBER LEGAL �Q �Iw \R;� �/�Qi
DESCR. I�? �J
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LI ENSENO. / -_7Z PHONE
USE OF -
BUILDING Rry t r8-"'T i A,
CLASS OF NEW
WORK ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK
9 r17
BEDROOMS_ DECKS CARPORT NOTICE
BATHROOMS ' TOTAL SQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
CONDITIONING.
NO.OF STORIES BASEMENT_ ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SQ.FT. Id[.�1� FIREPLACE COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT � SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CEFITIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI#TRATION LAW RCW 18.27,AND,AM-AWAJM_QF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ IREMENTS FOR WHICH THIS PERMIT IS ISSUED ND TH LL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN NFORMANCE HERE TH. HANGE HAL MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT INIM\GA'� B T.
APPROVAL FROM THE BUILDING DEPARTMENT.
XOI NE E X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES No YES No BUILDING VALUATION
HEALTH PUBLIC WORKS
FEE
PLANNING FIRE BUILDING PERMIT
J.O.T. BUILDING PLAN CHECK `
)PECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
p-3;
dC e'ryl- fr? r�C t 2� ��� �iT�C _. lG r SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE L
STATESURCHARGE
;ATION ACCEPTED BY PLANS CHECK BY APPROVE R ISSUANCE PERMIT VALIDATION
�� 12--1 -V5 BY': CASH CK MO TOTAL
PLOT PLAN
ADDRESS f� Q U L ✓/C��J/ L l�L( !'/��- (�ls�, 44
PERMIT NO o
0
LEGAL .S �. `� .i ' ` 5� � '
DESCRIPTION ', (A, LOT 8LK ADDITION "
ti �Y
SITE AREA=�100 0 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS/7 Sq. Ft.
I ,�
INSTRUCTIONS TO APPLICANT I
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.) 1r
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.
V
� y
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
n
1 �
r
'B
v� )
t
� •rw�j�v th+�ts�Dronosed construction will conform t0 t she dlrt>•nsio"s and uses shown above and that no changes will be made without
first obtaining appr
a5) All
1d(nw-Lye 4 L.}r
,ME(a) OF OWNERS) OF SITE 6 ST URE(S) ( IN SIGNATURE OF OWNER(S) OR AUTHORIZED R P ESENTATIV
T WRITE BELOW THIS LINE
APPROVED
'RICT AS NOTED DATE
LFA�F Awl':rywT
THIS 1,FA.;F dated this - dw/ of -��1�, ► )
In made by and hot.woon
hereinafter referred to as Tenant , aml Cn /1n/
SIZE ' .�-.r_ _...___... h t ' i n,�f i s r r s f 'r. r �' I t
Landlord;
W I r N F 5 5 1; 'r it
FOR ANir IN CONSIUFItATIUN sit lhr' nutuai Pr
euvBnants and conditions hvreinnfts'r net forth , the 1,inies
agree as follows -
A. f'RFMISES : The Landlor,l horvby leagns to thy' Tama
and the Tenant accopLu the dame , In the condition cut rent ly
existing in the following dencribod property located in the!
County of t1':iun, State of W.it3►tin hors : �1 _ �f%���_l, tl�
City of Aulfnir , County of Mason , 'tW - of WnuhivgtwN .
I) .TFRM: Thu term of this Ic A s- ,shall be lgonrH Td
C commencing on the
ST - S� play of. /5
--- 11 -�- .- -
19 ThI lease may he reno-wd an Iorovi Jed , n the
following paragraph.
C. ROOM This Wise nnnli hm automptically
fur continuing Q/sl� ��(�r,>N terrn_i nrrlr'!sss , At 1-Ar st thin-y
clays prior to the terminati _rn I.!it ' of this lenrsc, �' ith(�r
party t lie ruto ylvr's to t h o otI.-r party not i ((' Ita
intention to either terminate or to renegotlatc= this
Thar not I co o? I ntent. Ion Ln renvgot i A Lv fsh,% I I ho fl ',•1!1 -1 t r)
have the name vffeet nu a not i :e to t vininato. Any nuti to
LEASE A till:EM1:114 r - 1