HomeMy WebLinkAboutBLD26524 Mobile Home - BLD Application - 8/23/1990 ta `19N 1-fwy3
BUILDING PERMIT APPLICATION
2
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. ��JZ
OWNER NAME f MAIL ADDRESS CITY s STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE mtF n7?�e aviv 3 A3Ei- F,A,' VC-
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PARCEL LEGAL $H M d. i 1,64i R H.',N r 11 G`,p/P S
NUMBER / 'Z 3 Sa L1Ir�p DESCR. /y_1j
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. ZIP PHONE
CONTRACTOR �✓L
USE OF
BUILDING d Y►l r5
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS YOR N CARPORT NOTICE
TOTAL SQ.FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. TOTAL SO.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR 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. 13V2 TOTAL SQ.FT. CHECKONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTERWORK ISCOMMENCED.
PERMANENT FIREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
f
RS AFFIDAVIT CONTRACTORS AFFIDAVIT
FY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
ATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
EMENTS 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
FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
NG APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER'` DATE 7 - y X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVE NO DEPARTMENT YESPPROVENQ BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT '
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP �� PRE-INSPECTION
SHORELINE
WOODSTOVE ;
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION /
BY ld & — CASH CK MO TOTAL /7J
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PLOT PLAN
ADDRESS AL 2 `� �/ l t w lI 3 1.3 'e'_ti I-A £rPERM1T NO. 0 c
•
77
LEGAL
DESCRIPTION LOT BLK ADDITION _
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 AND 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
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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.
V 176 , i
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NAME(a) OF COWNE 1 OF SITE \ STRUCTURE(S) (PRINT) SIGNATUA NERIS) oR AUTM RIZED REPIOESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED n c
DISTRICT AS NOTED DATE / 24-- �011