HomeMy WebLinkAboutBLD27117 Roof Over Mobile Home - BLD Application - 11/15/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE /063
OWNER _ � - � �
DIRECTIONS
TO JOB SITE VEL. M45-DKLK• KD• 7-0 LAKE LlmEkxK DEvp-oPwtFNT• lugN nr 5 "m> ki6trr wro OLDE L h D�
PRmCEED %q, Mica' 7'uKN U-rF'f ONTO K1i-MR2NOeK RA • eowr(iNUC 7v 30,p Ho►tsc ON 1146 R(6WT
PARCEL I LEGAL
NUMBER 32,/27 SY ODOq9- I DESCR. / fZ !'7/v S "&q jg L/M137L�CL�
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP- PH
CONTRACTOR • SSiS CE OFFr .ty K B K i6NEE bMM C &t.fCH -bb3
USE OF
BUILDING Aoor, ovLow, ae ytrn 1 /►l cyf31L
CLASS OF NE ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK / ti r Vn OaO O i`E O lam F Wi2
BEDROOMS n DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR Al
BATHROOMS D TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. G��J FI REPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT L� SHORELINE
SEASONAL
OWNERS FFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRA N LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE NTS 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 CONF RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINI APPROVAL FROM THE BUILDING DEPARTMENT.c APPROVAL FROM THE BUILDING DEPARTMENT.
X O R' DATE /d��9d X BY __ DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION ,�.2 .S D -
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT O�
D.O.T. BUILDING W/'k PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
LJc/� SHORELINE
N1 G WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEEt��--
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS)CH K BY APPROVED FOR ISSUANCE PERMIT VALIDATION
(N SW /�-1 �� CASH CK MO TOTAL
PLOT PLAN
ADDRESS L yoo /ZiL/1'1A9aloc4 Rd S,4ffl14-01J ql'�54PERMITNO. 4 0
LEGAL
a o
a
i a
DESCRIPTION LOT 9 BLK ADDITION `,l/Y)A::��/C/L
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT Z
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 C,,
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. f< t�
b'
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
w.
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I/We certify that the proposed construction will conform to the dlmensidns and uses shown above and that no changes will be made without
first obtaining approval.
1, LE NE SifIrLL.Ey
NAME(a) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWN ERI 1 OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE VO'J,�q -y'�