HomeMy WebLinkAboutBLD0182 Mobile Home - BLD Application - 6/19/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. ( � I
NAME MAIL ADDRESS CITY R STATE 21P PHONE
OWNER e e 9"z
DIRECTIONS
TO,JOB SITE
LEGAL � (❑ SEE ATTACHED SHEET)
DESCR. ✓�G !oz � a.,�i*--J�i Z /l-;iA-2-4 A 4-/
NAME MAIL ADDRESS E LICENSE NO: PHONE
i
CONTRACTOR
USE OF
BUILDING ��/v� E L✓E= C G��`�Ci 1 /C/ 26
Class of work:- ❑ KEW ❑ ADDITION ❑ ALTERATION ❑ REPA ❑ REMOVE
Describe work:
Valuation of work: $ �+ C> PLAN CHECK FEE PERMIT FEE
1 SPECIAL CONDITIONS:
BEDROOMS (DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SQ. FT. GARAGE ❑'
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
f =ORIES -! BASEMENT ElATTACHED 1-1OR AIR CONDITIONING.
FT._fZ-'V 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 FOR A PERIOD OF ISO DAYS AT ANY TIME AFTER
I certify that I am a currently registered Contractor In WORK IS COMMENCED
the State of Washington and I aware of the FOR OFFICE USE ONLY
ord'�nance requirements regulating the work for which 'tl
th permit is issued and all work done will be in
c nformance therewith. PERMANENT A-" SHORELINES Wa
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED No
Li . o. Date ZONING
I PLANNING DEPT.
r'
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHALi
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
i, of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. Q MOTOR:VEHICLE PERMIT
S� Date. �/'— APPLICATION ACCEPTED BY PL NS CHECK BY APPROVE F R ISSUANCE
Owner BY.:
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
PLOT PLAN
' e
ADDRESS PERMIT NO. f o
R' >
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq.Ft. AREA OF SITE QCCUPIED;BY BUILDINGS Sq.Pt.
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 LNEW 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"'D SEWER SERVICE ,ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AN'D 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'
l
1
I/We certify that the proposed construction will conform to the dlmensidns and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S1.OF SITE.6.STRUCTURE.(S),(PRINT)- 'SIGNATURE OF OWNER(S) OR AUTHORIZED.REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING