HomeMy WebLinkAboutBLD9210 Mobile Home - BLD Application - 12/16/1980 BUILDING PERMIT APPLICATION r' `�
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED Q /�
100 PERMIT NO.
OWNER I ZNAME oil ZIP PHONE
• - 6 -4 7--?` 6
DIRECTI F�(
TO JOB SITE
LEGAL. o� (O SEE ATTACHED ET)
DESCR
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
1 ,/v f,—";
Class of work—. El NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: Z&z
1901
2(O oC
Valuatio ork: $ po PLAN CHECK FEE PERMIT FEE
SPEC L CONDITIONS:
vwz C Zl� 1
'4 gtA
BEDROOMS' {DECKS CARP RT ❑ !,r/ NOT C E
BATHROOMS (TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPA ATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE G DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State ofWashington and I aware of the FOR OFFICE USE ONLY
ordinance requirements
the regulating the work for which
the permit is issued and all work done will be in
Conformance therewith. PERMANENT [] SHORELINE
SEASONAL [7 FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING ^► v ��?
OWNERS AFFIDAVIT
HEALTH DEPT.
KS
I certify that I am exempt from the requirements of the FIRE MARSHAL ,
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will POAQ ACCESS
Abe/in conformance therewith. OT VEHICLE PERMIT
caner/i`�"r-ty �i�G�J2�[jate G l PP I TION ACC�EP B PLANS CHECK BY ABYP D FO ISSU CE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION �CK) M.O. CASH
7Pv Jac-A 7
Doo. oo
v
PLOT PLAN
ADDRESS S ► BOX .36.! BELF"A.1K , WA1 PERMIT NO.
N F N W 1
0
LEGAL n
DESCRIPTION LOT BLK ADDITION u
3 ACRES
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 P"'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.
fiINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
,a
U
M
N
IS r
I rIfy that the proposed construction will a nforfn to ti a nsio"s and uses shown above a :that no hanges will be made without
first obtaining approval. I U.,t y-
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNERIS) OR AU HORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED / J2/ �J� DATE 1
DISTRICT AS NOTED
SHELTON PRINTING