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HomeMy WebLinkAboutBLD24287 Mobile Home - BLD Application - 8/17/1989 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED - /7 0&x w !�, Z PERMITNO. �� NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER yEooce� �,�SiMMo,Js 3goi .✓�, ios S� S�4r, WA9.i2 � S2s_3o63 DIRECTIONS / [_L }(3D�� U/J i D 1� D1J S 2uaz S T TO JOB SITE �/� 70 f P T-�,S/ +Maus 260 uc PARCEL LEGAL. DESCR ,6 �NUMBEoVo a 5a aGY 3 ', / 1 NAME MAIL AD RESS CITY&STATE LIC NSE NO. ZIP PHONE CONTRACTOR , AllTe AcP 7P T USE /s v�L / Ir BUILDING �fS� � �IJ C� FA��'Di2;- CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ WORK DESCRIBE f��LI yE2 S r Y ©/1.J Sl rf r'fl 28�i�5�� r/�•Ng . C o AJ J c -t z o �' X I 17'1 � /�D Gc/ /e GlJ f� 7g 2 S BEDROOMS Z DECKS CARPORT N NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS `�_ TOTAL SQ.FT. GARAGE CONDITIONING. NO.OF STORIES BASEMENT N h ATTACHED 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 TOTAL SO.FT. �S6� FIREPLACE N � DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL OWNERS FIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY AT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRAT N LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIRE NTS 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 CONF RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINI APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. �j X Efi�' 'HATE �l- �/ X BY DATE FOR OFFICE USE ONLY DEPARTMENT YES PPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATIO HEALTH aA PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. Ibm BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE ,SUS7�'�i�7 S jIG S 2�- /Y/),ii�v �4'/�ID�•t(f PLUMBING xv MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION B . e f 7 CASH CK MO TOTAL PLOT PLAN ADDRESS ��`"�C �CZ S/ OWI, / PjA cl�T5�72_' PERMIT NO. 0 LEGAL 7q� DESCRIPTION LOT l 3 D � 1 0-+G� BLK Z ADDITION Cr K�(2 SITE AREA ��.�� Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS " 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. TEACH 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 AND 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 r GRAPH SQUARES ARE 5' X 5' OR 1"=20' Nd ir �1 3 v Q r a - — 1 2 C t I 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(SI OF OWNERS) OF SITE & STRUCTJRE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE