HomeMy WebLinkAboutBLD9949 Mobile Home - BLD Application - 8/26/1982 h BUILDING PERMIT APPLICATION
LI ATION
M A
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED l
PERMIT NI lisp
O.
OWNER N M M ADD WY&STATE ZI PHONE
1J I Nt 7� u QJ >BSo�IY s
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. GG / 7 • �ct� Un ` I a
CONTRACTOR NAME MAIL ADDRESS CITY&STATE 9CENSE NO. PHONE
USE OF
BUILDING
Class of work: A NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: '
x 9�y
Valuation of work: $ oc) PLAN CHECK FEE PERMIT FEE RS
S 6c S
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ 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 of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL L7 FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. L7
By Special Approvals IN OUT YES APPROVED NO
Lic. No. 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 BUILDING DEPT. 2
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be i c riformance t erewi MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLAN HECK BY APPROVED FOR ISSUANCE
Owner / p BY
P CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION ty M.O. CASH
4 A. PLOT PLAN
ADDRESS PERMIT NO. f o
= o
n >
s o
LEGAL
n
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.
4 - INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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.
E(31 F OWNER(!I) OF SITE 6 T UCTU ) (PRINT) SIGNATURE OF OWNE S) OR A�TA'ORIZED R PRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HKLTON PRINTIN3
�UfG/'� Claim o
pauytit�, �'/7
�CpI1di.M /VFgr,-"
1000
and )d j�a� �lSO Gals �i�j �
yQrc � d�mQl -
hU'c
I
IIC C 6
,and � ol� y q D J
.S)i e/1t/7 - 3
DEPTH OF \ / \
�`- BACKF)Ll
2"STRAW OR PA-PER \�
� O
f- I STONEj t �j
OVER 111E �g
E- PIPE SIZE
E STONE \ r 1 U P W
UNDER TILE
CR<)SS SECTION OF TR NC
FR
.iloS "y/-'3'6 A v�crG 5 /fje�Wlfma,+�
IA317 `f3 000 / � o/a7"V e-r rA0/�w
Y
NEl6Z3
SITE INSPECTION CHECK LIST NO
Check- every acceptable feature. Leave: every questionable or unacceptable
feature blank. Explain every blank in the space for remarks.
Item Applicable Regulations
1. Soil in holes-describe layers & depth Art. VI Sec. 3.5 (a) VII 3.3, 3.7, 10.2
v2. Existing sewage systems
3. Existing structures - check use VI 3.5 VII 4.1, 4.2
4. Existing wells - check construction VI 2.1 (b) VII 4.1
�,< 5. Presence of fill VI 1.8 VII 3.6
6. Has soil been removed VI 2.1 (c) , 2.4, 3.5(f) VI14.1
7. Salt water
� 8. Lake
9. Piver
'k 10. Creek
7�11. Stream "
�12. Pond/�13. Swamp,
_14. *,Iisc. Surface water
�15. Property V1 3.5 (f) VII 4.1
�16. Banks or cuts VI 3.5 VII24.1, 3.710.3 &
�17. Distance to public sewer VI 3.5 (g), ,
10.4
18. plater table - Pecord denth VI 3.5 (d) VII 1.4
�19. Slopes VI 3.5 (e) VII 3.7,4.1
�c 20. Driveways and roads VII 4.2
,,>- 21. Drainage patterns VI 3.5 (e) VII 4.1
,N- 22. Interceptor drains VII 3.8
23. Culverts
24. Water lines VII 2.6, 4.1
25. Flood control zones VII 4.4
_26. Roof drains VII 3.2
-'--27. Vegetation VII 3.2
REMARKS
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