HomeMy WebLinkAboutBLD94-0980 Mobile Office - BLD Application - 6/30/1994 '?tr!rt4 Y Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION Q
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 6(0
PLEASE PRINT _ S'y6a�
#1 Own E\ A W�+tyiik u it
Phone#
_tShaAd ess FJ q ��3 i_ Fire District# vZ
ity i St (,J(� - zip 9
Directions to Job Site Qk-b o kl_-1--• 4 'IkL�Cu, 'r-1 to r I A ( F 4 i l� Lxj Q G r2 0/n
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Owner Mailing Address ,
City c/ Zip
Lien/Title Holder
Address
Clty _ St Zip
Lj
#2 Contractor Name Contracto�Rbg #
Address Expiration Date
City St Zip Phone #
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply
Connect to Sewer System? Name of Sys
If residential, proof of potable water is required
#4 Parcel ` '` -il. , ��
Legal Description d d
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI /
Basement / Dec #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Ot sq. ft. /
#6 Use of building O F F► Ce c Describe work 0 F i C L
Von clRa\3cL_ P;-�
#7 Type of Job: New Add Alt Repair — Other 5610�4Vr'oc'-'
#8 MOBILE/MANUFACTURED HOME INFORMATION '/-
Model Year /;� Make2t'co Model D
kJ Length Width _Seri I No. hj �(oS(o—/4,1
# Bedrooms C #Bathrooms MOJE Type of Heat ELEG — {*SE
Purchase Price$ Q. 60
#9 Indicate by drcling the applicable source if any water is on or adjacent to subject property:
Rive Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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BUILDING PERMIT # q ,+ - 0 ( V C)
DATE 7/) I
Planner Area
CHECKLIST FOR PROPOSED CONSTRUCTION
Yes No .
[ ] [ ] Within 200 FT of designated shoreline, wetland, or
associated wetland
Where?
[ ] [ ] Proposed construction on/over/in wetland
[ ] [ ]] Proposed construction within floodplain
Eagle nest
State road access needed
[ ] Commercial Development (parking standards, sign
ordinance, public works review, other applicable
agencies)
[ ] [ ] Mobile Home or RV Park
[ ] [ ] Exempt from building permit application
[ ] [ ] Exempt from SEPA process (WAC 197-11-305, WAC 197-11-800)
[ ] [ ] Meets all requirements (which section(s) of SMP does
proposed construction pertain to?)
[ ] [ ] Variance or Conditional Use Permit required
[ ] [ ] Exempt from Shoreline Substantial Development Permit
process (Wac 173-14-040)
[ ] [ ] Exempt from Substantial Development, but within Army
Corp. jurisdiction (WAC 173-14-115)
[ ] [ ] Address needed
[ ] [ ] Directions needed