HomeMy WebLinkAboutBLD14552 Mobile Home - BLD Application - 8/17/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426.5593
DATE ISSUED
PERMIT NO. 14 55,
NA E MAIL A DRESS R GTY A STATE LP PHONE
OWNER geyt Y a� B Yff 142(0 9f9
DIRECTIONS I '13L4-LI WZ�
TO JOB SITE ReI '�(Q l/V�aSt�n e A t
LEGAL / ,/ (O SEE ATTACHE SHEET) AADESCR. /�, L>T;C I� i ✓-� L.O fi 17
CONTRACTOR N C MAIL ADDREBB CITY 6 STATE LICENSE N0. PHONE
USE OF
BUILDINGii C �C
Class of work: EW ❑ ADDITION ❑ ALTERATION 0 REPAIR G MOVE ❑ REMOVE
Describe work:
l 4-4 # Qb M. u C
Valuation of work: S PLAN CHECK FEE PERMIT FE .�
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT❑ NOTICE
BATHROOMS TOTAL SO. FT GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORIES_ BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. 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 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in
WORK IS COMMENCED.
the State of Washington and I am 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 SHOREUNESW
SEASONAL ❑ FLOODPLAIN ❑
=irm E.D. NO S.E.P.A 0
;y Special Approvals IN OUT YES APPROVED NO
_ic. 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 I$ Issued and that all work done will ROAD ACCESS
In con manse there ith. MOTOR VEHICLE PERMIT
_� r, / 7_ Y J' APPLICATION ACCEPTED SY PLAN CHECK BY APPROVED F R ISSUANCE
Dwne KrL�( Date . / 6' O BY
aP d
ILAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
/� c PLOT PLAIN \
%ODRESS ' a �'I �1 0 YI �pl PERMITNO. E
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y y / a
IESCRIPTION rl O LOT / BLK ADDITION ' /p P Jam/�Z "
;ITE AREA G Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS _Sq. Ft.
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 PAID 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 V-20'
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1/We certify then the proposed construction will Conform m tM dlmaroias and uses,shown above and that no changes will be made without
first obtaining approval.
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NAMEM OF OWNERS) OFF ITE A STRUCTUREISI IPRINTI SIGNATURE-OF OWNERISI OR AUTHORIZED REP ES NTATI� VQ
DO NOT WRITE BELOW THIS LINE
APPROVED (-7-
DISTRICT AS NOTED DATE
6NCLTON PRINTIry6
Show following on the site plan ' )
Lot Dimensions Fences iV
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography C C
Drainage Plan Wells /
Septic Systems Easements
Proposed Improvements Indicate Directional b
Name of Side Street y (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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S-Flo
ELK E
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