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HomeMy WebLinkAboutBLD91-28088 MOBILE - BLD Application - 5/14/1991 BUILDING PERMIT APP ICATION MASON COUNTY DEPARTMENT of GENERAL S RVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WA HINGTON 98584 427-9670 DATE ISSUED PERMIT NO. �� OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE 7 4� SOIL/ e--/ DIRECTIONS / TO JOB SITE � j[tS vS°i e5 p-1 _ PARCEL LEGAL NUMBER c� Cr'v0 DESCR. CONTRACTOR NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO. USE OF BUILDING ��jln�e CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK je-f`fivtc (( /7tet a �•z ��os�t er Yt I AREA: NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE jLU)SgFt STORIES SHORELINE❑ CONDITIONING. BASEMENT SgFt BEDROOMS 'Z PRIMARY RES.❑ THIS PERMIT BECq'MES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. CARPORT SgFt FIREPLACE IS CARPORT/GARAGE GARAGE SgFt ATTACHED❑DETACHED❑ OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I1 AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION W RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON ANµ,I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS OR 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 CONFORM#4CE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING AP ROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. XOWNE KIII`VW#tn#V DATE S�//��/ XBY DATE FOR OFFICE USE ONLY DEPARTMENT YEAPPROVEDJO DEPARTMENT YESPPROV NQ BUILDING VALUATION 0 4, HEALTH PUBLIC WORKS FEE ' PLANNING FIRE MARSHAL BUILDING PERMIT /U D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE.INSPECTION SHORELINE (Ole �-�� �� p '� WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE L APPLICATION ACCEPTED BY PUNS CHECK SY APPROVIO F R ISSUANCE PERMIT VALIDATION r B l CASH CK MO TOTAL ���� BUILDING PERMIT PLOT PLAN MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER P DIRECTIONS TO JOB SITE Y2 ✓11i��s eC 0 6: ©/Z + 5rl.29- d 0QC41 PARCEL LEGAL NUMBER 'l_� `l6 DESCR. 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. 0 O Location of proposed construction on property. O Building& septic system setback distances from all property lines& easements. Indicate North O Well and water line. In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage. O Attach copy of septic system as built' or septic permit approval. O Indicate topography profile of property and structure on reverse side. e% V ( V ao /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