HomeMy WebLinkAboutBLD10933 Travel Trailer - BLD Application - 7/6/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 ._• C ' d'` t
426-5593 —1-
DATE ISSUED
P
z., 12 PERMIT NO.
NAME MAIL ADDRESS CITY&STATE �� ZIP PHONE
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DIRECTIONS ��//.ILI %yC? S.ia� kl 0—r �� %d eC_ 2-a �2ado � � 3 I — Ces j L1®®- 'Str 2
TO JOB SITE O-P 0/c/ 6'eMC";'e l T1
LEGAL J f �n�nf ° ,+ (❑ SEE TTACHED SHEET) )
DESCR. / /� 1 f /��//� i �/Z
NAME MAIL AD STATE ICENSE NO. ONE
CONTRACTOR -- '=
USE OF
BUILDING '
Class of work: *-NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: r
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Valuation of work: $ _ PLAN CHECK F E PER
SPECIAL CONDITIONS:
BEDROOMS 1 DECKS CARPORT ❑ NOTICE
BATHROOMS ITOTAL SQ. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. I 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 FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor In WORK IS COMMENCED.
the Stake 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 v®
SEASONAL ❑ FLOODPLAIN ❑ -
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. 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 issued and that all work done will ROAD ACCESS
be in conformance therewith. MOT VEHICLE PERMIT
� LICAT NA TED BY PLANS CHECK BY APPRO'E��F ;SUE
OwnerDate . ? BY
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LAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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PLOT PLAN � � ,���; � —j�'� t a
ADDRESS -., .- 1 ' � PE M IT ni0! `� ' 1 t�J
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0
LEGAL n
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
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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 A"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.0 .
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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I/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.
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NAME(S) OF OWN ER(3).OF 31?E 6 STRUCTURE(S) (P IN TY� SIGNATURE OF OWNER R S) O AUT ORIZE REPR ENTATIVE
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DO NOT WRITE BELOW THIS LIME
APPROVED
DISTRICT AS NOTED DATE
6NELTON PRINTING