HomeMy WebLinkAboutBLD9552 Mobile Home - BLD Application - 11/6/1979 BUILDING PERMIT APPLICA 11U1V
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. C
MAIL ADDRESS CITY&STATE r�� X.
ZIP PHONE
4BUILDING
NAME ��%/ J u�r �/' ,�n 3 SEE AT`T'AC/HED SHEET)
W y ate+' er � 3 Web 1 `'��� LICENSE NO.
Tm v cITY 8 STATE
ME IL ADDRESSR� x 6
Class of work: NEW ❑ ADDITION ElALTERATION El REPAIR ❑ MOVE REMOVE
Describe work: led
PERMIT FEE o�nD, �
PLAN CHECK FEE
Valuation of work: $
SPECIAL CONDITIONS:
CARPORT I.i NOTICE
BEDROOMS F:A:
--- VEN71l
BATHROOMS_ . FT. GARAGE L] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING,ATTACHED I'_ OR AIR CONDITIONING.
NO. OF STORIES EMENT ❑ DETACHED [TOTAL SO. FT. PLCE ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHC
CONTRACTOR AFFIDAVIT SUSPENDEDITHIN 120 DAYS, OR IF
IS NOTMMENCED OR ABANDONED FOR A PERIOD OF 120 DAYS ATCONSTRUCTION
ANYOTIMEC
WORK IS COMMENCED.
I certify that I am a currently registered contractor in FOR OFFICE USE ONLY
the State of Washington and I am aware of the
ordinance requirements regulating the work for which
the permit is issued and all work done will be in PERMANENT SHORELINES 11
conformance therewith. SEASONAL I FLOODPLAIN 11
E.D. NO. S.E.P.A. I
Firm OUT YES
APPROVEI
Special Approvals IN
By ZONING
Lic. No. Date
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT 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 ROAD ACCESS _
which this permit is issued and that all work done will MOTOR VEHICLE PERMIT
be in conformance therewith. ROVED FOR I
I r /!O APPLICATION ACCEPTED BY PLANS CHECK BY
Owner
l!� � '✓ C Date . I �r
{I�
If
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O.
PLOT PLAN
PERMIT NO.
LOT
A BLK
Sq. Ft. ADDITION
AREA OF SITE OCCUPIED By BUILDINGS
INSTRUCTIONS TO APPLICANT �-� Ft.THIS FORM NEED
FILED WITH PERMIT
BE USED WHEN P
ERMIT APPLICATION. LOT PLANS DRAWN TO
FOR NEW BUILDINGS p (EACH BUILDING SITE M SCALE OF NOT PROPOSED CONSTRUCTION
THE FOLLOWING I UST HAVE A LESS THAN 1••_
SIONS. SHOW AND EXISTIN SEPARATE PLOT pLgN20 ARE
EASEMEN G IMPROVEMENTS SHOW IN TH NSPACE B
TION A•Ip SEyyER SERVICEINISH CONT ELOW:
SERVICE I ELEVATIONUSHOW OR pRAINAGE, FIRST F SITE, LOCATION OF
TION T L NES.SHOW LOCATION OF LOCATION LOOK ELEVA ApN SETBACK DIMEN-
HEREOF. SURVEY PINS.$P OF WATER, SEWER STR�E7- ELEVA-
ECIFY THE USE OF EACH BUILDING ND ELECTRICAL AND MAJOR POR-
INDICATE NORTH IN CIRCLE
GRAPH SQUARES ARE 5' X 5' OR 1"=20'
1
J
"We certify that the proposed construction
first obtaining approval. will
conform to the dimensions and uses shown above and that no
changes will be made without
ME(SI F OWN C
ER(9) OF BITE 6 STRUCTU
(S) (PRINT)
IGNATURE OF OWNER(s) OR AUTMORIZ
rRICT DO NOT WRITE BELOW 7- EO REP
APPROVED HIS L/NE RESEN TA TI V E
AS NOTED
L TON PnIN TINS
1 he rr