HomeMy WebLinkAboutBLD5350 Mobile Home - BLD Permit / Conditions - 7/1/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATEISSUED 7/ /7 7
PERMIT NO.
OWNER NA MAIL ADDRESS CITY&STA E ZIP PHONE
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)24k'
DIRECTIONS
TO JOB SITE ^Q CZt"�
LEGAL /� (❑ SEE ATTACHED SHEET)
DESCR. �
AME IL ADDRE S CIYY&STATE LICEN NO. PHONE
CONTRACTOR AD
4-4a, (I o
USE OF U � .
BUILDING
Class of work: ❑ NEW JVADD N ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
r
Valuation of work: $ _ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
LIGATION ACCEPTED BY PLANS CHECK BY TAPPD FOR ISS�ANCE Type of Occupancy Division
tl tt. Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
1 certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT. S
Firm PUBLIC WORKS
By ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL!, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
A L SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner .[ d),rj �L Date. L C WORK IS COMMENCED.
P�A CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION \CK. M.O. CASH
PLOT PLAN
ADDRESS jt PERMIT NO. s o
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s o
0
LEGAL � n
DESCRIPTION LOT L i a" ADDITION
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SITE AREA x'SG 7S 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 AND 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
1
l� 6
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.
NAMES) OF OWNER(S) OF SITE s STRUCTURE(S) (PRINT) 31 G N A RE OF OWNER(e) OR AU.THORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE