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Home My WebLink AboutBLD0168 Mobile Home - BLD Application - 5/29/1984 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426 5593 DATE ISSUED PERMIT NO. D l° OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE U _ * / DIRECTIONS TO JOB SITE L f/ L �9• LEGAL. (O SEE ATTACHED SHEET) DESCR G v CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE USE OF BUILDING Class of work: ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE W L ©en Describe work: Lf v -v /k/ X .�n Valuation of work: $ Oe% PLAN CHECK FEE PERMIT FEE n s— o .7 y, SPECIAL CONDITIONS: BEDROOMS_, I DECKS CARPORT C i NOTICE BATHROOMS__ TOTAL SQ. FT. GARAGE 1_' ATTACHED i . SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIESBASEMENT ❑ OR AIR CONDITIONING. TOTAL SO. FT. Z FIREPLACE X 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 conf rmance therewith. PERMANENT SHORELINES i SEASONAL I FLOODPLAIN 1 1 Firm E.D. NO. S.E.P.A. 1 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. of the Mason County ordinance requirements for which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT APPLICATION ACCEPTED BY PL NS CK BY APPROVED FOR ISSUANCE Owner—�� 67 Date. 1� L BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS PERMIT NO. f r a D (O LEGAL 1 DESCRIPTION LOT �C BLK ADDITION p 1 G; rJ u 'J w SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS yZ 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"ID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL l� SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. h J Qb INDICATE,NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' � 1 1 I V I� 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. bxt� 63MO-S NAME(S) OF OWNE (S) OF SITE a STRUCTURE(S) (PRINT) G NATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE E W THIS LINE APPROVED DISTRICT AS NOTED DATE SHELTON PRINTING 01 MASON COUNTY BLDD !j0- - INSPECTION APPLICATION / �jC*O —6 0 426 W.Cedar—P.O.BOX 186, Shelton, WA 98584 - (360)427-9670 $73.00 Fee Required prior to Inspection PLEASE PRINT Owner Daytime Phone# Site Address city Mail Address city State Zip Applicant Applicant Address city r� State Zip Parcel No. 190 ^ '5_1 — 0C) v�v Legal Description: Lrd5 Z) 4 L Purpose of Pre-Inspection: — / / / H Use of Building: Indicate by checking the applicable source if any water is on or adjacent to subject property: ❑ saltwater ❑ lake ❑ stream ❑ marsh ❑ river ❑ pond ❑ wetland ❑ seasonal runoff ❑ other Directions to site: Show the following on the site plan below: Lot dimensions, existing structures, structure setbacks, water lines, septic sytems, flood zones,wells,shorelines,easements,name of flanking and grontage streets. Indiate direction by N, S,E,W,etc. Applicant signature Date p . 30 1• $� Date: FOR OFFICAL USE ONLY - Accepted by: Returned to: Receipt No. -:1 DEPARTMENTAL REVIEW FO R OFFICIAL USE ONLY Planning: Proposal Proposal Approved Denied Building: Fire Marshal: Special Conditions: