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HomeMy WebLinkAboutBLD0325 Move Mobile Home - BLD Application - 11/13/1990 i BUILDING PERMIT APPLICATION a MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED 7 f �%1 I ICJJ OWNER NAME MAILADDRESS CITY TATE ZIP PHONE ��-Fr6fzb(I, "i Ri5iul . g(p= 6-9�'-4'-�I DIRECTIONS ��itic ���r ��Q�4ec� A.)&o27FJ 5402-r7- Qct. 'irae2t) pyCIOi ©y Sr'�ijb N�i- a-/� TUB d� TO JOB SITE 14ZLL 'T r- .? 4,t)6 S;qq Li--r, F01-Ullcj 2cC �7-o EWb PARCEL LEGAL NUMBER 10.32�-�2- )1©00 DESCR.Nz��uo=ys n3a1y N1✓j� S.;L� 2`f �. r"s �BcJ NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR USE OF BUILDING M©��r_r_— �ivrn-�- .. .�d - Hirs��ca s m;=S CLASS OF .�� WORK ,� NEWS�5 ADDITION ALTERATION REPAIR MOVE�Q&$,'lr_ REMOVE DESCRIBE ;z,C5 WORK I /YIO✓g� /14 (n-6- piwG Tc -rot, zo BEDROOMS DECKS 2- CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS_a TOTALS . 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 TOTAL SQ.FT. FIREPLACE 'F DETACHED ✓ ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT �_ SHORELINE A SEASONAL �r OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY T7AT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRAT N 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OkTAINIE GAPPROVAL FROM THE BUI/ GDEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. 0 ATE 1 ©�/ �) X BY DATE FOR OFFICE USE ONLY DEPARTMENT YES NO NO DEPARTMENT YES No BUILDING VALUATION Itt,"'36. J HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP PRE.INSPECTION d - �Piy► 1 SHORELINE 1r WO-7%/yGL✓Y Q i WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE �O STATESURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APJID F ISSUANCE PERMIT VALIDATION r Ll '� BY CASH CK MO TOTAL '/ '/"�Jl� BUILDING PERMIT PLOT PLAN MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED "�( J PERMIT NO. NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER le 1%`a -zzo i DIRECTIONS TO JOB SITE Rom,- _ i'!G10— 241, 7-4&eA.) #—/ eqdS� /�Q Tu.QirJ PARCEL LEGAL NUMBER j�3:Zi--z—Orec,o DESCR. vtJ� /yJ teJ4J Dv6✓ .S ,.Zg Indicate below: O Property lines and dimensions. O Easements and roads. O Septic, drainfield and reserve area, or sewer. O Septic tank and drainfield setback distances from foundations. O Location of proposed construction on property. O Building&septic system setback distances from all property lines& easements. O Well and water line. Indicate North O Saltwater, lakes, rivers, streams,wetlands, drainage. In Circle O Attach copy of septic system"as built" or septic permit approval. O Indicate topography profile of property and structure on reverse side. Room No\ ? w sut IasiJ (A FPI&ox v ao • w � (, o$ Eo 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 obtaini pr val. SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE I APPROVED DISTRICT AS NOTED DATE I 1 I I I TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE ' P i. S .w •j