HomeMy WebLinkAboutBLD22998 Mobile Home #34 - BLD Application - 9/27/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT Of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
_ 426-5593 DATE ISSUED <
rDIRECTIONS
NER NAME PERMIT NO.
MAIL ADDRESS CITY d STATE
ZIP PHONE
e t ,
OB SITE - O
C)
PARCEL
NUMBER/.;?3
DESCKI
CONTRACTOR NAME MAIL ADDRESS
CITY 6 STATE LICE S O. V
USE OF \ ZIP PHONE
BUILDING
CLASS OF
WORK r NEW mil_, ADDITION ALTERATION REPAIR
DESCRIBE MOVE REMOVE
WORK
oolf
BEDROOMS DECKS
CARPORT, NOTICE
BATHROOMS TOTAL SQ.FT. �_ CONDITIONING.
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
GARAGE
NO.OFSTORIES BASEMENT ATTACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SQ.FT, FIREPLACE COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE —11
SEASONAL
OWNERS AFFIDAVIT
CONTRACTORS AFFIDAVIT
I CERTIFY TH 7 I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATIO LAW RCW 16.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREME S 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
OBTAININ PPROVAL FROM THE BUILD�RTMENT.
IN CONFO ANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
APPROVAL FROM THE BUILDING DEPARTMENT.
X O R DATE S - c,
X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT 'ROVED
YES NO DEPARTMENT YES
BUILDING
HEALTH p
PUBLIC WORKS
PLANNING FIRE FEE
D.O.T. BUILD BUILDING PERMIT �-
ING SPECIAL CONDITIONS PLAN CHECKBUILDING GROUP A7�..
PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
3•
PPLICATIONACCEPTEDBY PLANS CHECK BY STATE SURCHARGE
APPROV/ED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY G�� C -,26 = CASH CK MO 99
.
PLOT PLAN
ADDRESS PERMIT�G' J�� S S t L /�� '� �7 PERMIT NO o
v
R >
LEGAL r
DESCRIPTION LOT BILK ADDITION
SITE AREA 5 �� —SQ- Ft. AREA OF SITE OCCUPIED BY BUILDINGS J j (y
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. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.1
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. �F
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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I/We certify that the proposed construction will conform to the dlmansions and uses shown ove and that no changes will be made without
first obtaining approval.
[lfY O N R{ I OF fl f RUC UR Ifl IRR NT1 16NATUR OF OWN ISI OR AUTHORIZED R A £SENTATIV
DO NOT WRITE SELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE