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HomeMy WebLinkAboutBLD12724 Mobile Home - BLD Application - 7/16/1982 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 7_ DATE ISSUED PERMIT NO. NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER 1 ' 1IS b DIRECTIONS `� p _ /� TO JOB SITE 41(o11W4 3©O O 5 L 9vAb R L Sow d 4h L� p ow 2 � LEGAL � pp ^ _ /� (❑ SEE ATTACHED SHEET) DESCR. S4 B D!y/S/o N 3 1-o 7- 5- &-f 134A.R-D�5 C-p IlG f6&{V&Lo rAn 67✓7— NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING 1 rfto#j� Class of work: Lt NEW 80 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: i Valuation of work: $ PLAN CHECK FEE PERMIT FE 14 , SPECIAL CONDITIONS: BEDROOMS I DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SO. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING. TOTAL SQ. FT. FIREPLACE [7 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 41a, SEASONAL ❑ FLOODPLAIN ❑ Firm E.D. NO. S.E.P.A. ❑ 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. /l/ jj`l 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 0 FLnO ICATION ACCEPT D&Y PIANSICHECK BY APPROVED FOR ISSUANCE Owner Date17BY P CHECK VALIDATION CK. M.O. CASH U FMRMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS PERMIT NO. f o z ° LEGAL n > a o DESCRIPTION JD) LOT BILK ADDITION RE A P.D 5 CO 1/,5- 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. 0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' FZ I/We certify that the proposed construction will conform to the dimensio"s and uses shown above and that no changes will be mad thout � first obtaining approval. NAMES) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED R RE7TENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE GHELT ON PRIN-IN�