HomeMy WebLinkAboutBLD27829 Land Clearing for Mobile Home - BLD Application - 4/5/1991 BUILDING PERMIT APPLICATION
/ MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. J t
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER
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DIRECTIONS
TO JOB SITE GO N NtPM4 SHME. D. FQoM 8F_L•�19. G-o .9 M1LE _Tt> b�}.I l RD. Caro ,45'
Mil F T U W.1 LQ cod L^asoAJ $L.V D. G-o • S Ml LE -r u.P-'%j (;� op-1 Al•E-• Vb. &e'
' HT`KT`A S 16- -LL T 'S tm
PARbtL LEGAL LOT E/te-D5 0�y1✓� U• DI��S.��.� L - D•
NUMBER �33D � DOO��, DESCR. /// _
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
E
USE OF
BUILDING Mo Nt E
CLASS OF NEW / ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE J_
WORK
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BEDROOMS DECKS CARPORT 1Ita- NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE VI/A CONDITIONING.
NO.OF STORIES ` BASEMENT A 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 ✓ DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE n/
SEASONAL K/
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION 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
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNEF '��+ DATE >'� f `II XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT
BUILDING VALUATION
HEALTH f` �� PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT J
D.O.T. BUILDING L PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
64s v �,� -� tT i L !4 SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHEC(KK BY (� FOR ISSUANCE PERMIT VALIDATION TOTAL J
CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP // PHONE
OWNER ¢ -�<, 6 /L
DIRECTIONS �o peTH Sf�Ae�-XD )=Aoln Re64 d G-o TD sated AVI A11/ �1�7 SS9
TO JOB SITE P.
. �Sin�/e f1///! o.J Secaad ScNc�.t v ' Thiel /-o7- ON
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PARCEL /.�3af0��O00 LEGAL �vE' ASort �
NUMBER DESCR. z ' '��,�5
Indicate below: Property lines and dimensions.
® Easements and roads.
® Septic, drainfield and reserve area, or sewer.
6 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.
Indicate North ® Well and water line.
In Circle @) Saltwater, lakes, rivers, streams, wetlands, drainage.
O Attach copy of septic system as built or septic permit approval.
0 Indicate topography profile of property and structure on reverse side.
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I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes ill be made without first obtaining approval.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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1 inch= 160.79 feet C, l
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1 inch =0 miles