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HomeMy WebLinkAboutBLD84-15489 MOBILE - BLD Permit / Conditions - 5/4/1984 BUILDING PERMIT APP ICATIGN MASON COUN Y P.O. Box 186 Shelton, Washingi In 98584 426 5593 !� (}-� DATE ISSUED �-ter— A PERMIT NO. OWNER NAME (� MAIL ADDRE CITY STA E y� ZIP HONE DIRECTIONS + � 7 TO JOB SITE ' ,a � ©�'11;a':eC.''�Irlti_ � 7�C� 70—QS✓'� LEGAL I Gtf ; �f (❑ SEE ATTACHED SHEET) ✓� DESCR. '0 �. rn4.at MAIL ADDRESS CITY&STATE LICEtjSE NO. PHONE CONTRACTOR USE OF BUILDING Class of work: ❑ NEW O AD pT p TERATION ❑ REPAIR XM VE ❑ REMOVE Describe work: Valuation of work: $ � � 5��—PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: BEDROOMS_ -3 {DECKS — CARPORT L'' NOTICE BATHROOMS I TOTAL SQ. F GARAGE L ATTACHED ❑ SEPARATE PER ITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT OR AIR CONDITI NING. TOTAL SQ. FT. FIREPLACE DETACHED ❑ THIS PERMIT BE DOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT IZED IS NOT CON MENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR'.kBANDONED 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 the aware of the FO O r r^^I w`E u■S E ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT L*111 SHORELINES SEASONAL L I FLOODPLAIN Firm E.D. NO. _ S.E.P.A. y Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. fY PUBLIC WORKSi 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 Kin formance therewith. MOTOR VEHICL PERMIT APP 'CATI ZC—CE PTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Owne Date . " BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN '90 ADDRESS 0 � PERMIT NO. 0g n D p O LEGAL DESCRIPTION LOT BILK ADDITION u SITE AREA 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 Ij 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 P"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. �.. INDICATE NORTH IN CIRCLE RAPH SQUARES ARE 5' X 5' OR 1"=20' r � I I 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. NAME(S) OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) sic TUR,E F WNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE SHELTON PR INTIN.B