HomeMy WebLinkAboutBLD98-0051 Garage - BLD Application - 4/30/1995 TA 3
Permit No.
MASON COUNTY OS /
BUILDING PERMIT APPLICATION %es
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 33/
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
PLEASE PRINT
#1 Owner CIV R oSe/n R,P/E' SP.4uLd a Phone# (S�)5-63- 7 2- 6 7
0Address k I p ro N TR S DQI vE Fire District#_
city c T N St wn zip yVY0
Directions to Job Site ! ! DAYToN 11R?o,er Rd. Go PAST CORREcTt- viv CE^'TER
vRl' Rl 4 T AT D 70.E T- AILS CNTRAlvC E' - GATE 7' 7'oP of Hit C TvRIv
/ T CAI p,4 ,41 INAIIS gW. , Go a' The 09 'FW4 oti The LEFT
Owner Mailing Address 5471 A DAV15 C/p2
City G c/9l'�E (f av X St44zip oZS'41--
A:i�itle Holder &NAy t �0S6M tG S/� dGplN�
Address 6 ( 9 01f,11S c oe
Clty (; s e4PC Cog St 1#,f Zip 4 z S-q 2.
#2 Contractor Name 0 w N169 Contractor Reg #
Address Expiration Date
City t Zip Phone#
#3 If septic is located on project site, include records. W� 93_p 6 78 )0fJ# " 60L--,A9
Connect to Septic? E S Public Water Supply W S
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
qo 15a
#4 Parcel No. ItZ 00 g -
Legal Description rOJv T ! L S L o 2 of oR T 2 2 S G
#5 Building Square Footage: -r'-Idt
1st FI / Q 9'3 2nd FI 4 Z 3rd Fl ft Basement
rooms 3 # bathrooms 2- Deck Other
G rage ! 25 �rQort (Circle:Attached r Detac
#6 Use of building Describe work
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#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year A114 Make _Model loVI✓1
Length Width — Serial No. I
# Bedrooms — # Bathrooms Type of Heat
Purchase Price$
#9 Indicate b circling the applicable source if an water is on or adjacent to subject roe
Y 9 PP Y 1 1 property:rtY: �0Iv5
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
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