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HomeMy WebLinkAboutBLD14022 Mobile Home - BLD Application - 5/25/1983 BUILDING PERM1t APPLICATION t' � r MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATEISSUED �L d PERMIT NO. OWNER NAME MAILADDR SS 1 &STATE _ ZIP PHONE DIRECTIONS TO JOB SITE C LEGAL „ (O SEE ATTACHED SHEET) DESCR. ` d 9—3-� NAME MAIL ADDRES I S STAT LICENSE NO. CONE CONTRACTOR l` 1; / Imo--( JV USE OF !a GC (I' BUILDING Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: -� r "1A Valuation of work: $ PLAN CHECK FEE PERMIT EE a o o Q_ SPECIAL CONDITIONS: BEDROOMS I DECKS CARPORT X NOTICE BATHROOMS ITOTAL SO. FT. ' GARAGEr . ATTACHED i ; SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES� BASEMENT Li OR AIR CONDITIONING. TOTAL SQ. FT.���1SL I FIREPLACE i DETACHED i_1 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 tj SEASONAL I , FLOODPLAIN i.I 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. - a PUBLIC WORKS I certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for BUILDING DEPT. which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT AP LIGATION ACCEP ED BY PLANS CHECK BY APPROVED FOR ISSUAfjCE Owner Date ld*,.. (J�IJQ PIV CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS PERMIT NO. f o .74 LEGAL © /' l ^ D1=SCRIPTION LOT BLK CJ ADDITION l�a'( /G`a 6'I • * UPI r P SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft. � ' elc q y�,'7 INSTRUCTIONS TO APPLICANT tn) w C t_ f 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 A"'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. 0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Tel f , I G� 1 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. _._.--------- - -— - � a (5) OF OWNER(S) OF SITE Q STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED `T AS NOTED DATE V F`R;N TINu 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 CITY&STATE ZIP PHONE OWNER ij?S 1 L DIRECTIONS I�/G�/'C 5� DaI /9KG //�G� /'LOL /o �`" .Y/ /�t/ �i�IL07✓� TO JOB SITE CAI-&Aj �'� 7i9 s r�- T'e•r/ LEi�T,Tu1 T�,��.,.Ll v�o�! Stu enT �i��e.C. PARCEL LEGAL G/AacAj- /fI�R/so !.(+CJ121C / 1LI19LseAC NUMBER �3�. -(� DESCR. 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. 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. fv 4 a , v Z J I/We certify that the proposed construction will conform to the dimensions an uses show4above qnochs made without first obtaining approval. SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE -�t- s 3unio His 30 NOliVOO-1 aN`d kiH3dOHd dO 3-1UGHd kHcAVH9OdOi