HomeMy WebLinkAboutBLD61391- MOBILE HOME/STORAGE ONLY - BLD Application - 6/13/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED < y /
PERMIT NO. / �r
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS .{
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PARCEL LEGAL
NUMBER DESCR. j :;L'�' - (go
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK /
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AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE �t 'S'qA STORIES I SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES-4 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS I SEASONAL RES.❑ COMMENCED WITHIN 180 SAYS, 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 U DETACHED Cl
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 AND 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 WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNER DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
(. � �- SHORELINE
�'o ' v, nc WOODSTOVE
PLUMBING
e rn MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY 1,,APAQIkVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
Y _ CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAM AIL ADDRESS ITY STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE
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PARCEL LEGAL
NUMBER /' I DESCR. 3 �a3S �Sa I
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.
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I/We certify that the proposed construction will conform to the dimensions and uses shown abov and that no changes will be made without first obtaining approval.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
�s� �_ APPROVED
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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% PMV % M
Np� p 21991
3ENESAi �ERViGE�
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