HomeMy WebLinkAboutBLD29639 Mobile Home - BLD Application - 12/2/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME Az4ee,
I ALAESS /��� ITY&SjAT; ZI� PHQ�I)C-�S�
DIRECTIONS r ��I, ��--((�� �e h / d as JJ
DI JOB SITE Wo Lg
fin � S 4� ovaPARCEL L.
NUMBER '�Z�3U '� bUall D SCR.�% of
$—
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE n o/%
BUILDIDI (/�,v7NG
CLASS OF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
WORK DESCRIBE �-�tSTGItiC
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED D DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I 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 EREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH,NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPRO M THE BUILDING DEPARTMENT. / APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNER DATE r / X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT41
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PUNS CHECK BY PRUED I E PERMIT VALIDATION
TOTAL B ASH CK MO v
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
N M E MAIL ADDRESS CITY STATE ZIP PMONE
OWNERDIRECT
ONS
TO i /��`�Gi �o� � �Q � Lem-TO JOB SITE i
f7 6 1 5/_ L—
PARCEL LEGAL
NUMBER I)l 2?,36 76 b o6 G I OESc;; I 7k
Indicate below: O Property lines and dimensions.
O Easements and roads. •
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
0 O Building & septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system"as built'or septic permit-approval.
O Indicate topography profile of property and structure on reverse side.
VI I
I
1
UWe certify;hat the proposed consmic;ion wil!conform to the dimensions and uses shown above and;hat no charges will be made without first obtaining approval.
SIG•va7URE OF Ow�ER(S)OR AUTHORiZ_o R5=R_R='47aT1y=
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
I ( I I ( I
II
_ _ I
I .
(•rap tA" ;E
bo
1 c°°
tb �,
�,4����r�� �'t"� s�0� °' �A,��� it'd �' 'n•� 4n
W � w
0�^
Ij
RAI
dr
^ gt,
l�r T J�� Je V V� t� •J �• u, -t t„ t, p, y,
c N 9oyfi q< -4t N
wok
�1 4� SCr✓ODr1�ErC tpp� `04'1,
art
�• y.�5 Y i yJ� r s-G
10 �1 4' ' 4-.ZJ,
� ., fa
3 b9 J sb 4 3� �n I c a t iti
.Ns�
4
L1
tn
� N
rr w y4w w w -d/ �Y
..7 wi2 31
3-3
w
3 ',� - -
�(�' ba/�y �`'�L
3 W �,
a
��\, y `�K
---- ��
r ��
,� /
��
�b
��