HomeMy WebLinkAboutBLD29898 Mobile Home - BLD Permit / Conditions - 2/4/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
•el DEPARTMENT of GENERAL SERVICES
r� f 426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER -3 l�Z.-T6 WA-
DIRECTIONS
/ T
TO JOB SITE J-T,� tDAyToN ^ aww Lcr(TN 6 141&-H�'T�D /Qp. 7 u/C-/v /q! 6-tj T aN
PARCEL
NUMBER (/ �V�6 (� DESCR. S l L� SL /VII ul T'aWA #, �c 0 5E_ _ ! O
NAME MAILADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING �( (L
CLASS OF IJEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
WORK DESCRIBE _ /Lf G,C/C 7 ) C'v/�� �� '1 ( L
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
Q,�� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE D' 0 SgFt STORIES�_ SHORELINE❑ //4 CONDITIONING
BASEMENT AA SgFt BEDROOMS _ PRIMARY RES)o THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS �SgFt BATHROOMS SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT_ I 7 SgFt FIREPLACE_' IS CARPORT/GARAGENA
GARAGE tJSgFt ATTACHED 0 DETACHED❑
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,
X OWNER DATE y - X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVED�O DEPARTMENT YEAPPROVED,O BUILDING VALUATION
HEALTH f 1� PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMITGJ j
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY APP 411D ISSUANCE PERMIT VALIDATION
-� BY -- CASH CK MO TOTAL �J
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 CI 7Y 3 STATE ZIP PHONE
OWNER
OIRECTIONS
To JOB SITE
PARCEL `' LEGAL
NUMBER 4�Ib 24 l9off, I oESCa. I s Lx--) L3
Indicate below: 0 Property lines and dimensions.
0 Easements and roads.
m Septic, drainfield and reserve area, or sewer.
® Septic tank and drainfield setback distances from foundations.
® Location of proposed construction on property.
® Building & septic system setback distances from all property lines& easements.
Indicate North 0 Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage. -
In Circle O Attach copy of septic system"as built" or septic permit-approval.
O Indicate topography profile of property and structure on reverse side.
I
II I
I
I I I
6
__FTT I ff, __LL_Lj
II
1P,Ve cert` ;1dt;nd pr000 ied corts;runo'wl' :onf.r^i w '1@ C n e^i r 1 I.
i �Cns and uses s`Jwn above did;13t f10 Chd^S?s'Hill bd,Zdd....a wit1�V,tifs;Jirf3�r'i^G d70 J' d
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
I
f ( I I
( I I I
I I I I
I I f I I I f t I I I I I (
I f I I I I f I I I I
I f I f i t I l l i l I
IIII
I I f
II II
II I I
1 1
i h i l l
III
f
L