HomeMy WebLinkAboutBLD28973 Move Mobile Home - BLD Application - 9/8/1991 BUILDING PERMIT APPLICATION k"a" " I#
MASON COUNTY 3 0 700 S
DEPARTMENT of GENERAL SERVICES ewA6'12! /)` •�.,�f
P.O. BOX 186 SHELTON, WASHINGTON 98584 ` " J
427-9670 DATE ISSUED
PERMITNO. �8
NAME MAIL ADDRESS CITY B STATE ZIP PHONE
OWNER � `'Co a41 'l1zFWqZ RY360 l'a G✓� 9'BS�
DIRECTIONS TO JOB SITE u 1/"// J- O Nc,tnes rAz ,C. Ilh;v - Ol 75-5�
PARCEL ` LEGAL
NUMBER 0-yy-000 DESCR. ��d h Cou e o✓ - ,C .o7 '�-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR c
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE 'A A
WORK —two(i elpZ X t7 A�� /-O , --o 017
It
O o ^ ; h. -a 0 call
BEDROOMS _ DECKS YO N� CARPORT NOTICE
�. TOTAL SO.FT.
BATHROOMS DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SO.FT. TOTAL SO.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y O N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA /�� BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. q6 d TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT _ FIREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT 1 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.
X OWNER�/i'l-1{�� !/ ''�`�'DATE �� ��- y� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
p SHORELINE
G WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE 5-D
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY�/ APPR D F SSUA CE PERMIT VALIDATION r-+�
OT/ 'pO 'a [0y �, ASH CK MO TOTAL _@//)
PLOT PLAN
ADDRESS /{/, (� � ` ��/ /1/�i i'a� CJ� ' �(/�Q ) GS COuePERMITNO. 0 0
s
Parse / # /,Z3 3o 'Sy, o60u5 a
LEGAL LOT BLK ADDITION DESCRIPTION ,(/,y, 7 w
SITE AREA Scl. Ft. AREA OF SITE OCCUPIED BY BUILDINGS f)
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 AND SEWER SERVICE ELEVATION. SH )W 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 �y GRAPH SQUARES ARE 5' X 5' OR 1"=20'
cL l--
e
,
a
_ F 3
o4 M7
I'
I/We certify that the proposed construction will conform to the dlmaraidns and uses shown above and that no changes will be made without
first obtaining approval.
N1,4 x; N A) C C O wz4111
NAMUS) OF OWNERM OF SITE S STRUCTURE(S) (PRINT) �IGNATU, OF OWNER(!) OR AUTHORIZED REPRESENTATIVK
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
I