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HomeMy WebLinkAboutBLD1606 Mobile Home - BLD Permit / Conditions - 3/12/1975 6t4.1al" 16pdjs 4 i6o� ' 3 � • BUILDING PERMIT APPLICATION MASON COUNTY P. O. Box 400 Shelton, Washinqton 98584 D a DAT_E_10,17CT: �� — F Applicant to complete numbered spaces only. MIT N0.__�6 U JOB ADDR ESS LEGAL �� ^ 1 DESCR. / / ._ n �I i f/� EE ATTACHED SHEET) OWNER MAIL ADDRESS ZIP PHONE Z U ✓ I S �1 l r,� S. C R/jjj of Y r1 3 Y e t fiv l,c �S 7`l 7 CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 3ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. 4 ENGINEER MAIL ADDRESS PHONE LICENSE NO. 5 LENDER MAIL ADDRESS BRANCH 6 Se p-T7cc. - tcs� q �A J� e,ne e USE OF BUILDING 8 Class of work: ANEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 9 Describe work: 7L C CS C)P 3 /L /4 10 Change of use from Change of use to 11 Valuation of work: $ / C 0. 00 PLAN CHECK FEE PERMIT FEI� LJ C)C� SPECIAL CONDITIONS: J C� Type of Occupancy Const. Group Division Size of Bldg. No.of Max. (Total) Sq. Ft. Stories Occ. Load Fire Use Fire Sprinklers APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Zone Zone Required []Yes ❑No �J _ o. of OFFSTREET PARKING SPACES: 46i�/C Dwelling Units Covered Uncovered N 0 T I C E Special Approvals Required Received Not Required ZONINC. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT. AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Soecify) TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. SIGNAT fiE OF CONTRACT OR AUTHORIZED AGENT (DATE) _,,L 3 . J-) - T_ SIGNATURE OF OWNER I► OWNER BUILDER (DATE) PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH SHELTON PRINTING CO. / PLOT PLAN ADDRESS { O- B © � ~ PERMIT NO, 60 CS 0 f ° = o n�f n 1 LEGAL 47T_n-1-'�l6T 9 a DESCRIPTION LOT BLK ADDITION U SITE AREA 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 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 A"'D 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. 0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' R p � N 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. ) LdLJ1S NAME(S) OF OWNER(S) OF SITE d STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE SHELTON PR'NTi1—