HomeMy WebLinkAboutBLD16753 Mobile Home - BLD Application - 4/29/1985 r r
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 7/
DATE ISSUED
PERMIT NO. Al z 1-5
OWNER NAME MAIL ADD ESS CITY STATE PHONE
to j
DIRECTIONS
TO JOB SITE VQQ/npa fa � , y� �
LEGAL (❑/SEE ATTACHED SHEET)
DESCR ack5 of, w w l ! "`-' Y'4
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
USE OF
BUILDING ��a ! 1 o rae
Class of work: >1 NEW El ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ✓
Valuation of work: $ Q� i/ PLAN CHECK FEE PEg�I FEE
SPECIAL CONDITIONS: �6
i
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SO. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORI S� BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the fate of Washington and I am aware of the FOR OFFICE USE ONLY
ordi ance requirements regulating the work for which
the permit is issued and all work done will be in
co formance therewith. PERMANENT SHORELINES;Q
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT. ' Gl 7
OWNERS AFFIDAVIT HEALTH DEPT. tJ-�L-4 f' ly-PN-95 -
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be i onformance th r th. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner �)�ate � Befs
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
1
PLOT PLAN
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ADDRESS PERMIT NO. F o
LEGAL �Ir�L""'"
DESCRIPTION LOT C� BLK ADDITION a
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 P"'D 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20A i. I
SA 141
lot
I
I
- i
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. /
NAMES OF OWNER(S) OF SITE 6 STRUCTURE(S) (P T) IGN R WNE7 R AU
RTHORIZED RESEN TA T I V E
O NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
� • . • • •
FOR DEPARTMENT USE ONIY
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SEPTIC TANK (S)/;L GAL. PUMP
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• • •
DISTRIBUTION TILE TOTAL FEET
r m�. NNW& AFILTRATION AREA TOTAL- SQUARE
rFINAL INSPECTIONBEFORE
DEPTH OF
BACKFILL
FiffiAN-500WAKUP0 2"STRAW OR PAPER
STONE
, • •,., .�L�•jA •VER TILE
<- PIPE SIZE
SITE PLAN . • SPECIAL UNDER
DIRECTIONOF D'AINAGE) CROSS SECTIONOF
EVEN
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