HomeMy WebLinkAboutBLD16087 Mobile Home - BLD Application - 9/7/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
q l PERMIT NO.
N // MAIL ADDRESS rr ,�IVV I 8 ST T P PHON
OWNER IL 'S C, /Y .� i S� J 7
DIRECTIONS �-
TO JOB SITE JR ►nQ/
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. / 1
CONTRACTOR NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describ ork: ' n
Valuation of work: $ PLAN CHECK FEE PER IT FEE
.Qz ao. or)
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT LI NOTICE
BATHROOMS TOTAL SQ. F GARAGE 11
ATTACHED i-: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT Li 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 1 FLOODPLAIN
Firm
E.D. NO. S.E.P.A. [:1
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWN RS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am ex mpt from the requirements of the FIRE MARSHAL
contract or registra on law RCW 18.27, and am aware BUILDING DEPT.
of the Ma n C unty ordinance requirements for
which this p r it ' is a that all work done will ROAD ACCESS
be i cc an here MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
O Date/
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO C . M.O. CASH
PLOT PLAN
ADDRESS ¢°*t` z: '7/ [ JJ _ - PERMIT NO. o
i o
n D
LEGAL
DESCRIPTION ���" 3 LOT lQ BLK ADDITION ���*
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,ANDSETBACK 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.
t W
0 INDICATE NORTH IN CIRCLE / GRAPH SQUARES ARE 5' X 5' OR 1"=20'
t
�r
I/We certify that the proposed construction will conform to the dimensirtns and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRIN TINS