HomeMy WebLinkAboutBLD0400 Replace Mobile Home - BLD Application BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMITNO. r ZO
NAME MAILADDRESS CITY BSTATE ZIP PHONE
OWNER u A z - e v '77 1:. aW6 ^Id el j a I r LL)tgsr4
DIRECTIONS
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DESCR. Eui5 spllwrf wr:liC.f1' r 7 ZJ,zC l TJwlo.5Ex a=T4 SWX4
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR AI1ILkICpaJUSEOF
YI�IOt3/�E O
BUILDING ,BLS EAhfL
CLASS OF ADDITION ALTERATION REPAIR MOVE NEW REMOVE
WORK ✓ I
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DESCRIBE { L1'7 I l V U D 1�� t �.J� I U_J � 1 ► I�i IV 1�/�
WORK
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BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
2/ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. i5 FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT 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
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
"X OWNER DATE �' tl- �' X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION
HEALTH V PUBLIC WORKS FEE 1
PLANNING FIRE BUILDING PERMIT C
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANSK 8� APPROVED FOR Ir.SqNCE PERMIT VALIDATION
BY X i CASH CK MO TOTAL
I
o PLOT PLAN / 93OG J1
ADDRESS ,�+C Z� J� --� 1+�IL�i-i.V PERMIT NO. o
ELL IS ZSknY�OwT T21L�1! fILA[7 2
LEGAL
DESCRIPTION LOT BILK ADDITION u
SITE AREA /S,400 Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS ?-041n _Sq.Ft. fft N
ALTUAL IAS i:�SS L7r- 25,6a0_,,a rr INSTRUCTIONS TO APPLICANT N
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"- 3
FILED WITH PERMIT APPLICATION. (EACH B 20' ARE
BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: AN.)
OF n 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.
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'PXJIL)Id— S. rl�' IS KFO l7 aDY 3 A, 'f4POG S47jlc �, ahou' �
kEAo.&IL,ur IZo&j)
r INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X VOR 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 mode without
tint obtaining approval
YA J( 'z - MA-rij L-✓ic.d
NAMEISI OF OWNERS) OF SITE a STRUCTURE(S) (PRINT) IONATURE OF OWNERM OR AUTHORIZED REP SE TATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
S-ELTON PRINTINp
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