HomeMy WebLinkAboutBLD12007 Mobile Home #316 - BLD Application - 2/8/1982 C,574
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593�v DATE ISSUED
tt✓uJ 14r_� —3 1 LP PERMIT NO. /6?400 7
OWNER NAME Mary Jo Ui►9 MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS 'f
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
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NAME MAIL ADORESS CITY 8 STAT LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING \- `X-C\rz_
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR g MOVE ❑ REMOVE
Describe work: /
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Valuation of work: PLAN CHECK FEE PERMIT FE �=�}
SPECIAL CONDITIONS: 5 r
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT.C j(La0 FIREPLACE ❑ DETACHED L THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. 2-3 2—
PUBLIC WORKS
I certify that 1 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 cinnP. ill R ACCESS
be in co formain the with. MOTOR VEHICLE PERMIT
y_ �8/ LICATION)CEPT D BY PLANS CHECK BY AP OVED FOR ISSUANCE
Owner 20r. Date. I�
PLAN CHECK VALIDATION CK.. M.O. CASH P MIT VALIDATION CK. M.O. tCASHO
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• PLOT PLAN
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ADDRESS /, O. 6()x J f PERMIT NO. 0 �Aa
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LEGAL �`Vrq r
DESCRIPTION F 5 .. F.PS LOT G'tCP�_ BLK ADDITION �
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT 1
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE t
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- T
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA• �.J
TION P"'D 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. CT
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' j
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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.
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NAME(S) OF OWNER(S) OF SITE R STRUCTURE(S) (PRINT) IGNI�, OF OWNER(SI AUTHORIZED REPRESENTATIVE
W HIS DO NOT WRITE BELO LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3