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HomeMy WebLinkAboutBLD20564 Mobile Home - BLD Application - 7/7/1987 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 7 426-5593 DATE ISSUED PERMIT NOS D?l' NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER „c ,� iY liJ Z7 L DIRECTIONS TO JOB SITE ( i V1311-145-le lc;ccaej� lea on rr1a�c,Ii 0 p"r sl I PARCEL LEGAL ti� 1 t C o/ NUMBER lZ3Z© l 3 O 1 DESCR. 104 Sec.Z0 e 1 23 NAME MAIL ADDRESS CITY&STATE v LICENSE NO. w ZIP PHONE CONTRACTOR WA USE OF BUILDING 1�c we- CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK r I WORK DESCRIBE belt- <- X L "" , J BEDROOMS 3 DECKS CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS 1 TOTAL SQ.FT. GARAGE CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT 4-- SHORELINE`-- SEASONAL 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 C NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBT ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. N E R "' 1 DATE X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO HEALTH Rgt( PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING l PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP P 3 PRE-INSPECTION weu �.nr.9rc.1e. Cl r SHORELINE WOODSTOVE ' f PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR IS ANCE PERMIT VALIDATION TOTAL �� BY CASH CK MO • �� I� PLOT PLAN ADDRESS PO Box (OZJ S`Na 14— Oc + zg? PERMIT NO. � o LEGALO""['"r DESCRIPTION LOT BLK ADDITION -- j 1 u SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 1 �T 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.) 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. INDICATE CIRCLE IN NORTH GRAPH SQUARES ARE 5' X 5' OR 1"=20' O LE ;� VJ to I 1 to 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. re c PC(A + N E(s) OF OWNERS) OF $1TE a STRUCTURE(S) (PRINT) I ATU E OF OWN�ORAUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE J tihe)I �Jp � -