HomeMy WebLinkAboutBLD82891 Demo Old Bldg. - BLD Application - 8/28/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED Q�j
PERMIT NO. �u 1
SMEL&�41i3
MAILADD SS CITY&STATE ZIP PHONE
OWNER A2 � .c�J, l S/ �.l /3c7 f�ri�'GJti ?S .)- 2-73--6,Y37
DIRECTIONS
TO JOB SITE A)
LEGAL
N U M B EPARCEL Z31C' Z -CltJc+LG row1- DESCR.
NAME MAIL ADDRESS CITY 8.STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING < ;O/Lr`;l�l' j
CLASS OF NEW ADDITION TALTERATION REPAIR MOVE REMOVE
WORK r // / /
WORK DESCRIBE �.t++✓E fd J d 2J:A-) LA)W I 1/ t1i
ic clJ)vv- /'tAIA AJCf�
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS SEASONAL RES.Q COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED Q DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE„THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPR L FROM THE BUIL ING DE. TMENT. ,�• APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER / DAT �i X BY_ __ DATE
OR OFFICE USE ONLY
DEPARTMENT YESPPRovENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
- - TOTAL l
BY CASH CK MO
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S.Gordan Cc jQ
.� the
mason county asses
Qe have recsncly reesived a copy of Cartilieata for mobile home
aovemanC on your mobile home.
f Za ocdec chat we wayaccuraesl value you oobila haae
y 7 . ploase Complete
ehe questions below and return this tors to our ofiica by
Ic is imperative that this iaformatiou be pra.i2md-to prevent a
possihl• double ass+s-meat.
boa LL EECME QATA Lim= QZaT$
TTA it
UCEZL= .RCIar- LCCA=CM INF0221ATIMI SERIAL Ye; `y
A— • -hy pc-ivacaly a-mad laud_ M= �
E_ I.1 canted or Laased Land who fra.e?
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anrn:5 �,.�, _
C_ ile a L P ro pe cty Pa MA I I (CA= stateaanC #)
Q MailLas andyaddress' lot owmac of mobile &saw
HAME
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AD0R�5 &x S/4.s- I3C CZLr b MIS ��o, d,
Location address of mobile hao.e,2(o(� %
F. Daca mobile hove was placed on present size
e_ Pucebase
DAI=: S IG`(Ai i7HE1A 00 I
TYPE 03 PILW NAI-Ir
Ts'..I HOME d l%_ 3
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
4P7_g=7n
PIErZMI'r NO.
NAmE MAIL ACOPIESS cir a s,ArE Z1P P"IONE.
OWNER �0. aA- 275 6 4'
OIREC71CNS �-7
70 108 S17E WeoI. V
266•1 101J ddQ,, kw-\l 1
PARCEL
LEGAL
NUMBER I OESCA. I • f6 1-1 -O /0 V RJUt.[1scJ
Indicate be!ow: r Prope-,, lir• - and dimes'—s.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances fron foundations.
O Location of proposed construction on property.
O Building & septic system setback distances from all property lines & easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle 0 Attach copy of septic system"as built"or septic permit-approval.
O Indicate topography profile of property and structure on reve se side.
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TCPCGRAPHY PgCFILS CF P.ciCPSATY ANO LOCATION CF STRUCTURE
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MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O. Box 186 Shelton, Washington 98584
(206) 427-9670
building environmental health maintenance landfill parks&recreation fair/convention center planning sewer&water
August 9 , 1991
Dennis Ward
P.O. Box 5145
Belfair, WA 98528
Re: Demolition of structures
Mr. Ward,
We recognize the situation and we feel that we can work with you on
this. If you can meet the following criteria:
1) the residence that is being used for storage must only be used
for storage.
2) at no point are you of anyone else to occupy the building.
3) this sheet must be signed before we can issue the permit for
the mobile.
4) please let us know if the existing structure has a septic or
not . Due to the fact it needs to be demolished also.
I Dennis Ward do hereby agree to the above terms and agree to act
on the in a timely manner.
I'1av,. � AI_ ,1 )Cl�►�
Dennis Ward