HomeMy WebLinkAboutBLD14891 Mobile Home - BLD Application - 11/2/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED_
PERMIT NO. ,q '
NAME MAIL ADDRESS CITY&STATE pp ZIP / PHONE
OWNER f' '► (�' 0 P7et 130, GAT
DIRECTIONS ,j
TO JOB SITE S O n� L i/V V G T TO
LEGAL �'" C rL N tN T-c�- C) (❑tEE ATTACHED SHEET)
DESCR. .. c�_ _ f
NAME MAIL ADDRESS CITY STATE LICENSE NO. PHONE
CONTRACTOR 1 r ��r� ' 3� ) _ " /p
USE OF -C
BUILDINGS 'F�C_
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: lq Z 4- a
l
Valuation of work: $ PLAN CHECK FEE PERMIT FEE !o) 7
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT G NOTICE
BATHROOMS (TOTAL SQ. FT. GARAGE '_:
SEPARNO. OF STORIES BASEMENT El ATTACHED I OR AIR
ACONDITION NG PERMITS RE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SO. FT. FIREPLACE 11 DETACHED (l
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 F O R F F I C E USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL I , FLOODPLAIN
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. pK
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. ,,I'� (J MOTOR VEHICLE PERMIT
�A _ /u�'v o PPLICATION ACQXPTfD BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date . BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
L
PLOT PLAN
ADDRESS PERMIT NO ` 4 S 4 o
4 0
= o
11 D
LEGAL a n
DESCRIPTION LOT BILK ADDITION u
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 Al"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'
XK J -Z
G
C
L )
I/We certify that the proposed construction will conform to the dimensicros and uses shown above and that no changes will be made without
first obtaining approval.
r-\ P o h
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNA RE OF OW RI ) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW T IS LINE
APPROVED
DISTRICT AS NOTED DATE �'L1 �3
i
SHELTON PRINTING
SEWAGE SYSTEM PERMIT APPLICATION No. Permit Expires
MASON-COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY
ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPT NO.
303 NORTH 4th STREET • SHELTON, WA 98584
PHONE (206) 426-5561
APPLICANT SIGNATURE
ADDRESS PHONE
PROPERTY OWNER SITE: ❑ Approved ❑ Not Approved
ADDRESS PHONE B Y.
DESIGN SYSTEM REQUIRED
SEWAGE SEWAGE
CONTRACTOR DESIGNER
INSTALLATION: ❑ Approved ❑ Not Approved
LEGAL DESCRIPTION
BY
DEPTH TO WATER TABLE
TYPE OF NO. OF LOT
BUILDING BEDROOMS SIZE X SOIL TYPE
SINGLE RESIDENCE PUBLIC WATER
WATER SYSTEM SYSTEM NAME
COMMERCIAL ONLY
LIQUID WASTE G.P.D.
DIRECTIONS TO SITE:
SEPTIC TANKS) GAL. PUMP REQ.
DISTRIBUTION TILE TOTAL FEET
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
DEPTH OF
BACKFILL
2"STRAW OR PAPER
STONE
OOVER TILE
F PIPE SIZE
< STONE
SITE PLAN AND SPECIAL STIPULATIONS UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
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