HomeMy WebLinkAboutBLD2237 Mobile Home - BLD Application - 5/19/1978 X2
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED SA 5? 7E
Joe,�'-/ /�J/L� 't/ r��,- PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
'Z.
DIRECTIONS
TO JOB SITE AL 2�� — ✓mot GQ� GQ eGcE y�l',/�Cr`.
LEGAL _ (❑ SEE ATTACHED SHEET)
DESCR.
CONTRACTOR
AME AIL ADDRI S CITY&STATE LICENSE NO. PHONE
� � LL • 3" �
USE OF /` /� Q •
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAI ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE �U
SPECIAL CONDITIONS: IF
�p
d
APPLICATION ACCEPTED BY1 PLANS CHECK BY AP ROVED FOR ISSUANCE Type of /q7� Occupancy Division
COn�st Group
Size of Bldg. No. of Max. ✓ -
(Total) Sq. Ft.J�� � Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I Certify that I am a currently registered contractor In RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In c 9formance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Ow r '�` 8t@ WORK IS COMMENCED.
7V
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
I
g S-C, C
SITE INSPECTION NOT DONE DATE INITIALS
1. Soil Log Holes Needed •1.
2. Directions Not Clear 2.
3. Property Not Sufficiently Narked 3.
r f 4. Not Legally Available for Development
4.
V 5• 5.
SITE INSPECTION DONE; I:'EED MORE INFORMATION
1. Winter High Water Study Necessary 1.
2. Insufficient Lot Size for Set Back Requirements
2.
3. Soil Not Suitable for Standard System 3.
4. High Ground Water Evidence 4.
5. Severe Topography 5.
6. Property Not Legally Available for Development 6.
U 7. Deep Soil Log Holes Needed to Depth 7.
8. Submit Designed System 8.
9. Submit Plot Plan 9.
WATER SUPPLY
1. Well Site Approved 1,
2. Well Site Not Approved 2.
/ / 3. Preliminary Report Approved 3.
4. Final Eater Report Approved 4.
CONSTRUCTION INNORMATION
Z 1. Red Tagged Sewage System
1.
/ 2. Certification of Water System 2.
Z 3. 'VIater System Not Approved
3.
Z 4. tlait for As-Built S -�3-) g' 4.5 23 _
U '_ Water System Approved 5,