HomeMy WebLinkAboutBLD22420 Move Mobile Home - BLD Application - 7/29/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 J
427-9670 DATE ISSUED 1"+��
PERMIT NO.;; f
OWNER NA MAILADDRESS CITY&ST /e ZIP ONE
h'i i A
DIRECTIONS
TO JOB SITE 17� zo4/;O A/.
91
PARCEL y 9 LEGAL �'
NUMBER 30l Jr0 3'y G SCR. if(G'T --;'s
CONTRACTOR NAME MAILADDRESS CITY SSTATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF WORK ✓ NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK lYl'r r AF 101 e lei e /►'I X� -V 7V T f
t
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. p FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIST _ION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR 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 CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI G APPROVAL FROM THIBUILDING TMENT. ry APPROVAL FROM THE BUILDING DEPARTMENT.
X0 E ms►^ J�L� //
X BY DATE
(1-1-tbR OFFICE USE ONLY
DE RTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING ( FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP ,� PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY ����� CASH CK MO TOTAL �,
PLOT PLAN
ADDRESS PERMIT NO.LEGAL 4
Z1 41;,04, �� 3 ��� l�On/ /*01� CAV,95 o
a
DESCRIPTION LOT .2 1 BLK ✓ ADDITION Ai 'gWA Vr --*Pl • ziQ 4
SITE AREA/ 7 re SQ.Ft. AREA OF SITE OCCUPIED BY BUILDINGS 700 Sq. Ft.
o
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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
a
Q
mat
•
I/We eertif o ructiontill conform to the dimensions and uses shown above and that no changes will be made without
fi obta`I a rov 1. [`�
NAME(e) OF OWNER(S) OF SITE • STRUCTUREIS) (PRINT) SIGNATURE OF OWNERIS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE