HomeMy WebLinkAboutBLD12239 Mobile Home - BLD Application - 4/6/1982 * ' BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED (v L Z I L '�. PERMIT NO. 1aQ 3�}
7
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
03 cv o 27
DIRECTIONS 1tf;s"� 1N'"!';s - f. ,nps6a,/ + U'v`:A'� Corr.��y,....�t
47
TO JOB SITE Z. "�'^
LEGAL (❑ SEE ATTACHED SHEET)
DESCRdel T
NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. RdONE
CONTRACTOR
USE OF
BUILDING �
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION 4 REPAIR EVUOVE ❑ REMOVE
Describe work:
d ' X4J
Valuation of work: $ 2 a O , PLAN CHECK a / FEEn PERMIT FEE � S
SPECIAL CONDITIONS:
BEDROOMS__ DECKS CARPORT ❑ NOTICE
BATHROOMS�,r TOTAL SO. FT. GARAGE f7
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT G ATTACHED Ll OR AIR CONDITIONING.
TOTAL SQ. FT.t/_57a, FIREPLACE L. DETACHED C
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 I,
the permit is issued and all work done will be in
conformance therewith. PERMANENT : SHORELINES &1
SEASONAL [-, FLOODPLAIN LI
Firm E.D. NO. S.E.P.A. L]
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. ys g
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
/J AP LIGATION ACCEP E BY PLANS CHECK BY APPROVED FOR ISSUANCE
Ownn �-l� t�t��t�� Date. BY
P CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
1 ,
' - PLOT PLAN
ADDRESS PERMIT NO. s o
x o
LEGAL
0
ESCRIPTION ya,,;dIQTS BLK ? r ADDITION u
SITE AREA I% fC i�l�_Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS i/ .:2 Sq.Ft.
INSTRUCTIONS TO APPLICANT
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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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.
NAME(S) OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED '7 DATE
1 6H ELT ON PR�NTIN3 - - -