HomeMy WebLinkAboutBLD17495 Mobile Home - BLD Application - 6/6/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 8 STATE _ ZIP �� PHONE
DIRECTIONS 1 KI 6ri dc7f'Ct�Lvt`r� .Z`cctii� �d-��rs�
TO JOB SITE s �
LEGAL , n (❑ SEE ATTACHED SHEET)
DESCR. fr�4,[ o/ZQ�
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
USE OF �
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $/ �j(a PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT l 7 NOTICE
BATHROOMS (TOTAL SQ. FT.T2-q- GARAGE
ATTACHED I: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT " OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED u
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
jea
I am a currently registered contractor in WORK IS COMMENCED.
Washington and I am aware of the FOR OFFICE USE ONLY
uirements regulating the work for which issued and all work done will be in
therewith. PERMANENT SHORELINES
/) SEASONAL I i FLOODPLAIN
Firm /
E.D. NO. S.E.P.A. I
By � Special Approvals IN OUT YES APPROVED NO
Lic. 19kP)U ryI H/607P14 Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. War S,
PUBLIC WORKS
1 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 ther with. MOTOR VEHICLE PERMIT
LICATION ACCEPTED BY PLANS CHECK BY AP OR ISSUAN
Owner D to . is B
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
/j/'�� t ./
ADDRESSl,i �l — '�1�JrI � E R M I T N0. 4 °o
P D
LEGAL
DESCRIPTION LOT L( BLK 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 A"ID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL N
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
r
I INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' �-
(
cx
3
r i
N
I/We certify that the proposed construction will cq form to the dimensions and uses shown above and that no changes wil be made without
first obtaining approval. I �Q
ka_ct r E <S. A R Tte)d
felh'kl 7? kfi"Oe j r
NAME(S) OF OWNERM OF SITE h STRUC REM (PRINT) IG TU OF OWNER(SI OR AU 5_R CF FTEPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING