HomeMy WebLinkAboutBLD13836 Mobile Home - BLD Application - 4/13/1983 BUILDING PERMirAPPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 r��
426-5593 /
DATE ISSUED /
ELF MIT NO. �
OWNER NAME MAIL ADDRESS CITY&STATE 'SHONE
DIRECTIONS
TO JOB SITE ,-3&/6 S&-4; 4 yz SCV L t-
O, 5�7r/�/•
LEGAL / (❑ SEE ATTACHED SHEET)
DESCR.7=0 d !� 6 DT
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING -c7y
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ / PLAN CHECK FEE PERMIT FE�
02
SPECIAL CONDITIONS:
BEDROOMS__— DECKS CARPORT ❑ NOTICE
BATHROOMS— TOTAL SO. FT. GARAGE ❑
ATTACHED i ' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [ ! E OR AIR CONDITIONING.
TOTAL SO. FT/2,3Z. FIREPLACE I i 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 q -
conformance therewith. PERMANENT SHORELINES a/
SEASONAL I I FLOODPLAIN [1
Firm E.D. NO. S.E.P.A. [I
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. -Fr3
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
A LIGATION AZb
CC PTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owne do . BY
V
PL CHECK VALIDATION CK. M.O. CASH VPERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS o)G PERMIT NO. F
0
i o
n s
LEGAL
DESCRIPTION LOT 4NEW �� ADDITION-eew"'5
G
SITE AREA J �' Sq. Ft. API'I'-AREA OF SITE OCCUPIED BY BUILDINGS /---1--3�2- 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
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
h
CL
OOOF
`.
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.
I YA REA/L ETT" �c _ wry
NAME(S) F OWNER(S) SITE h STRUCTUREM (PRINT) IGN URE OF WNER(S) OR AU HORIZ RE ESENTATIVE
DO�WRITE BELOW HIS LINE
APPROVED
DISTRICT AS NOTED DATE
1 6HC1
1
ON PRINTING
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