HomeMy WebLinkAboutBLD15252 Mobile Home - BLD Application - 3/16/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426 5593
DATE ISSUED V
PERMIT NO. 6?- �a)
AME r MAIL ADDRESS CITY&STATE ZIP p PHONE
OWNER C �.`�I-L� �L. vd, A.0 a;nn.rt W ^ 0
DIRECTIONS a�
TO JOB SITE J C,. ok'or-A q t1C"0j Cc•h.t1 (/t� pI d CAuG, de ChK0.( ku lnr(LEGAL K
W 30 �O-� ,O 0 "4 �� �Q� ) /7 ,-rA/. .11 Al (�. 3 ACHED SHEET)
DESCR. j61 ' L� �.
J('CONTRACTOR
NAIu MAIL ADDRESS / Jul CITY&STATE if LICENSE NO. PHONE
R
USE OF If�Ul
BUILDING / 4F_
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ .51 PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:�"`/�
BEDROOMS I DECKS A=P CARPORT 11 a NOTICE
BATHROOMS_ TOTAL SQ. FT.19 GARAGE CL 8
ATTACHED i ; {� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE C: DETACHED Ll
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 ✓
SEASONAL [1 FLOODPLAIN I.]
Fir If E.D. NO. S.E.P.A. I !
By
Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
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 c nformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner" r Date . . eee� BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS OC.-It VJ 4 ��' f��I �" r/�� PERMIT NO. f o
/ i o
3 G ' n—!' / +n' o L o
LEGAL
DESCRIPTION LOT BILK ADDITION
SITE AREA 3.Obbb Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS
'°`Q INSTRUCTIONS TO APPLICANT �0
S �p
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE C \
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 rl
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION ARID 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.
T C-
n. to
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=2.0'
AL
°a
k
i l r�r
I/We certify that the proposed co struction will conform to the dimensic/ns 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 N ) OR AU TH RIZED RE ESEN TATIVE
DO NOT WR/Tf BELOW THIS LINE R
APPROVED
DISTRICT AS NOTED DATE
61-IELT0111 PRIN-i IN3
2 times me neiV of S tructwe Top of _i3= r�"►►"iq a.
Slope Ca of
13 Maz.v Fawirq
Not to escaed 40'a-
Facs of �Tce_ of
SlrI ure I Slope '
w= .
�E BUILDING OFFICIAL MAY APPROv'
TYPICAL STRUCTURAL SETHACx ALTERNATE SETBACKS a CLEARANCES
Score I' = 20'
Scmple Site Plan
24I'
I S3' 14
`40 32' 20' I
_ o
PROPOSED lic ,
RESIOENCE L
feau
Septic TantJ
£DGE OF BANK
24' f e
� a
56
r
238'
moo.S'"feect well(see#21
I
U
TYPICAL SITE PLAN 1" = 20'
J. OOE 1406 Mason U. Or.
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