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Home My WebLink AboutBLD29820 Mobile Home - BLD Application - 1/10/1992 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED c � Ile Ili" Al PERMIT NO. OWNER NAME MAILADDRESS 7 CITY SSTATE ZIP PHONE DIRECTIONS TO JOB SITE � ' /, ) 'r/ e E(-ri4 h Qe n c Z IK 64 Hw S PARCEL LEGAL NUMBER �3 ZZ �(, �. DESCR. 07- i1C F # /3 CONTRACTOR NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO. USE OF BUILDING ,CS CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK r DESCRIBE WORK H� AREA: NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE/�_SgFt STORIES SHORELINE❑ CONDITIONING. BASEMENT.,f/A SgFt BEDROOMS 2 PRIMARY RES.6- T++ISpERM1T BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS SgFt BATHROOMS Z SEASONAL RES.❑ COMME D WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED R A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. CARPORT-4/14 SgFt FIREPLACE_ IS CARPORT/GAW GARAGE IVA SgFt ATTACHED 0 DETACHED❑ OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY I ED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE HE ORDINA REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE P IT IS ISSUED AND WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THERE .NO CHANGES SHALL BE MADE HOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM T UILDING DEPARTMENT. NER FN PATE �1 _ X _ DATE FOR OFFICE USE ONLY DEPARTMENT YES NoDEPARTMENT YES No BUILDING VALUATION y0 �I HEALTH PUBLIC WORKS FEE PLANNING FIRE MARSHAL BUILDING PERMIT ag ZJ D.O.T. BUILDING 1)4 PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP EjrDIC6 PRE-INSPECTION SHORELINE WOODSTOVE C a ' PLUMBING 50q/o 5 6� ;Z �� MECHANICAL STATE BUILDING FEE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION Gv� 12 - �-r�/ TOTAL 3 '7S BY I- D �Z. CASH CK MO PLOT PLAN Roo kPoc �� P, 1 r, woo q r��-�S r ADDRESS y; _t��1�'-Y�f'(a CL��=�-b kk k 1 (� C�j" b PERMIT NO. ° o n > LEGAL y'P# l %k DESCRIPTIOfffffKff � LOT C BLK ADDITION ° u SITE AREA 30 000 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 V 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 AND SEWER SERVICE ELEVATION. SH(oW 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' r` J �4ilgl I E Vo C AN rl L I I 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. n PRoP NAME(a) OF OWNER(a) OF SITE • STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE