HomeMy WebLinkAboutBLD24015 Mobile Home - BLD Application - 7/6/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 n
427-9670 DATE ISSUED 4y
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER Gera 2� lea le a �I�FU e¢,b/c ���f6�1 (1t�f� gSsSg �fi6 qb
DIRECTIONS - /_.
TO JOB SITE a/e o ld! L ne P ^1j ! e l/ra -0r
*f4- -t-0 E I IfD K4 S'j 111& 6 r0a 4 ZL IF
PARCEL LEGAL
NUMBER .-q/a'7 54 DD/I S` DESCR. L
NAME MAIL ADDRESS CITY&STATE LICENSE N . ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS WORK O✓ NEW X ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE /�� L
WORK �� l/�-?I UI e- hu-)'xe- 11
BEDROOMS DECKS t CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS Z' TOTAL SQ.FT. frARAGE 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.1 d FIREPLACE 0 DETA HED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS FIDAVIT 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
CERTIFY
ION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS 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 CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI NG APP/RROVAL FROM THE BUILDING DEPARTMENT. cc, APPROVAL FROM THE BUILDING DEPARTMENT.
NER /� � DATE �-23 d / X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO i
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK '
SPECIAL CONDITIONS BUILDING GROUP 3 PRE-INSPECTION
V O d rt t4 SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICA ON ACCEPTED BY PLANS CHWA BY APPROVED FOR IPSUANCE PERMIT VALIDATION
TOTAL
C �,� BY 7V'` CASH CK MO '
PLOT PLAN
ADDRESS yD PeG6/CS OA . S'41 � [SA- PERMIT NO. t
� _ o
LEGAL 'KL/I�
DESCRIPTION LK L/,zP_r, OT J I BILK l` ' ADDITION
SITE AREA 1'22V 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 m
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) tr
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- V
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.
�I
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
cy'
T
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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.
F �r (�-
NAME(a) OF OWNER(a) OF SITE i STRUC TURE(S) (PRINT) If:NATURE OF OWNER(S) OR AUTHORI EO REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE