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Home My WebLink AboutBLD28707 Concrete Forms - BLD Application - 7/30/1991 BUILDING PERMIT APPLICATION 7&. MASON COUNTY C /\-u DEPARTMENT of GENERAL SERVICES ` � 426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. JL �1 NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER o - !U• - lZ5 51�6- 2 DIRECTIONS �a TO JOB SITE �Ol I �2 p✓ cs 6 G /?I �/ r IL -pl PARCEL r LEGAL NUMBER �� 7 L67� 2-1 DESCR. / Cx� /�� _/(iz NAME MAIL ADDRESS CITY&STATE ZIP PHONE UCENBENO. CONTRACTOR - USE OF J BUILDING _ CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK r DESCRIBE WORK 46c/ `!/J c. i.s ¢ >✓ S / t c u AREA: r NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCEFt STORIES SHORELINE❑ CONDITIONING. BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS S Ft BATHROOMS SEASONAL RES.O 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 U 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 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 y DATE _ X BY_ DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO ) HEALTH PUBLIC WORKS /FEE PLANNING to1 FIRE MARSHAL BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP �� PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE " APPLIC — A JTION ACCEPTED tY PLANS CHECK BY APPR E R IS A CE f' [PERMIT VALIDATION / " � 7 1 ,� ASH CK MO TOTAL BUILDING PERMIT PLOT PLAN MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 4P7-g9�7n PERMIT No. I N 7-7 E a+L A010AESS t d taiE ZIP P>-sCNE. CWNEA u14« it/i �� " s�0 OIRECTIaNS r [� TC 1CS SI7c !` e / /'�1ti'✓ 1 c fc__ y`C �S ✓l �4��iZ t>�`� t 1/�5 r O✓�,Y 1 ( I ( PARCEL LEGAL NUMBER I I OESCR. I / l ✓• S L�j�" Z ' P I rn-PT Indicate below: <' Prcoer';• tin,,- and dimen5 - O Easements and roads. O Septic, drainfield and reserve area, or sewer. 0 O Septic tank and drainfield setback distances from foundations. O Location of proposed construction on property. 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 profil of property and structure on reverse side. ( ! I I III IIIII I I •I H I 1 I I I I I I I i I I 1 I I I I I I I II I I I I I I i l I I ! I ( I ( I I I I I✓ I I Pit I I I I I I I I I I I I I I I I I I Isl I I I I I l l l l l l l f I I I I I I I I I I I i l I l l l i l ) I IIIII i l l l l l I I I I III I I I I � I •1 S: __ ... . _ _.-2^S•.:r'S 3rtG u52i S'�+�dCJ�?3'_:13f;.J�`3'�dS �:II�2,-y__ .r.;1�'_.,'irS:�b:1�'�"y' 1�=�='�dl. TOPOGRAPHY PROFILE OF PROPERTY ANO LOCATION OF STRUCTURE I I I I I I I I I I II III I I II I I I I I I I I I I I I I I I I Lj I l ( I I I l I l f I I I I I I I TT l i ! IIII I +j-L I I I I I I I I I i t I I I II III ( I ! I I I I I I I I I I I I I I I ( I I I I I I I I I I I I I I III I I I I I I I I I I I I I I I ( I I I I I I I I I I I I I I I I I � I III I I I II I I I I I II II� BUILDING PERMIT PLOT PLAN MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME qq AIL ADDRESS CITY&STATE ZIP PHONE OWNER _64 h<=e /1/1/Cnl ►'� a /j S- S/Z S j, S�� DIRECTIONS l TO JOB SITE aloc r I a.�2 I{ ' V PARCEL LEGAL / NUMBER DESCR. .n S /�/, 2 y 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. � I r`1 - /' nin approval. I We certify that the Proposed construction will conform t thdimensionsn o n h han es will be made without first obtaining pp / fy P P oo ea du�sS17 oynab�ea dt atnoc g SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED ra,Gore= C=tg -k the aSOV Comty assessor- nsa r We have recently cetaived a cagy of tax certificace for mobile ba.ee movem.anc on your mobile ham.. Ia ccdac that we may•accuracely value you oobile base, please coaplece the questions below and return [his focm a g t our office b It is L=peracive that Chia Laformation be pravt;Ied-co prevent a passible double assmssmecc. um LL Halle aATA L = MGM MArV' -menu. 23,E A- • -Mr privately o••aed had_ 30 E_ IL` rented or Leased Land .rbo from? .nnSri� "Y1 err s sra� Sib . /A,. �i'gS3Zy C_ ZRA L ?rapwr_y rarCeI # (ea= sriteseat #) a MziLiag aasv and address foe a.+nec of mobile base KAULP G fat rn i b Anal=s_ go/. Ak# S/ Crrr s MTXI a`► � M_ Location address of Aobile home.C/ CZT't F. Dace mobLlc !sane was pierced on prescat SLIC C. Pure!3a1e .-C, ` j l� DAZ=: I7PE 02 PYLIT NA?—ic