HomeMy WebLinkAboutBLD91-28257 MOBILE - BLD Permit / Conditions - 6/3/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERALSERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WA HINGTON 98584
427-9670 DATE SS'
PERMIT NO.
!!AM MAILADDRESS CI ryB STATE ZI PHONE
OWNER .. er s Z a /L. �� �l� �r C W4,3321
DIRECTIONS
TO JOB SITE 4Y1 e. "c) hall ()Y-r � 9 -� -�
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PARCEL LEGAL
NUMBER DESCR. r
NAME MAILADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING Mob,
i�6 M CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ �7
WORK DESCRIBE J G. 40
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE qa'j08gFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CO STRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTI N OR WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS Z, SEASONAL RES.❑ ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED❑
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 Ah D 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 WH CH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE HEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. { APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE Z �` X BY DATE
FOR OFFICE USE ON LY
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION r 1�
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT ,-
D.O.T. BUILDING 'l�L�, PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP �? PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY A. V FOR ISSUANCE) PERMIT VALIDATI N
BY/ 6�-y/ CASH CK MO TOTAL j
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSU D
PERMIT N
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER SF- S--Z
DIRECTIONS
TO JOB SITE
QOo(j)
PARCEL LEGAL
NUMBER J� g
ZOv -� DESCR. � ZO d
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
0 O Building & septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system "as built' or septic permit approval.
O Indicate topography profile of property and structure on reverse side
IV
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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.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
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