HomeMy WebLinkAboutBLD18114 Mobile Home #1 - BLD Application - 11/1/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
.� 426-5593 f'
DATE ISSUED f/ o
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE
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DIRECTIONS 1, A� Enr.� pf /V1`�k/i'�tc
TO JOB SITE n'1�1� N9 ew r.� N 4i,.Acl�c /? rl�Sl'
LEGAL _ (❑ SEE ATTACHED SHEET)
DESCR. 71 5 S'(-fJ 94 —�3 —�
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR F e C6 11.,m-
USE OF I(/ �/C/ _ KJ
BUILDING f-lom-e_ SG�-�nC-�
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
Valuatio of ork: $ PLAN CHECK FEE PER IT F
SPECIAL C NDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIE BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AfkIDAVIT 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
je
at 1 am a currently registered contractor in WORK IS COMMENCED.
of Washington and I am aware of the FOR OFFICE USE ONLY
requirements regulating the work for which
is issued and all work done will be in
ce therewith. PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. N Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
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 ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
AP ICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING
�.r PLOT PLAN
ADDRESS IVC—_ (O QCK VDIV14RArt PERMIT NO o 0
= o
LEGAL
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'
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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.
NAME(S) OF OWNER(31 OF SITE h STRUCTURE(S) (PRINT) dIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
1 CHRISTMASTOWN PRINTING