HomeMy WebLinkAboutBLD28962 Mobile Home - BLD Application - 9/4/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 Q
427-9670 DATE ISSUED
PERMIT NO. 2W"
NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE
OWNER -�2/0 - -
DIRECTIONS TO JOB SITE 7 �z m 14 9 S7` ,e C 6
PARCEL LEG=-7-
NUMBER 14 9OD� DES T 3S v1
CONTRACTOR ; E r MAIL ADDRESS CITY BSTATE ZIP PHONE LICENSE No.
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK '- - tfq o
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE-&D SgFt STORIES ! SHORELINE❑ CONDITIONING.
BASEMENT C' SgFt BEDROOMS PRIMARY RES.0 4-- THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS ef� SgFt BATHROOMS 'Y SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT '�-'7 SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE I SgFt ATTACHED U DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH,NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE j'` j� X BY_ DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVENo_ DEPARTMENT YES No
BUILDING VALUATION
HEALTH Ja_ PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING 6- PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP pttJ61Ljr PRE.INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY P VED ORTSSUANCE PERMIT VALIDATION
CASH CK MO TOTAL ,C-� 72
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 96584
d77-99.7n
PSPMt7 VO.
N A M c C,r d S7Ai c ZIP Pt!ONr=
Pr
aIREC TIC NS -
a ,CS s7= �i� .� /�-t i , /1�D,� eD lit' Ic F
NUMBER °`"' 172 T� 3 s 7
Indicate ,Ze!C,.,,: r Prc, er,
O Easerents and roads.
O Septic, drainfield and reserve area. or sewer.
O Septic tank and drainfield setdack distances fron foundations.
O Location of proposed construction on property.
O Building g septic sys:_m settack distances from all property lines easements.
Indicate North O well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O A`ach copy of septic system"as built" or septic permit-approvaL
O Indicate topcgraphy profile of property and structure on reverse side.
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