HomeMy WebLinkAboutBLD23299 Mobile home - BLD Application - 1/30/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED/
PERMIT NO.S=2---3z2 99
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE Me
e reeJ
DIRECTIONS
TO JOB SITE
PARCEL LEGAL ?
NUMBER 32/3(c � IbOCa1O DESCR. TR
SF NE NW
NAME MAIL ADDRESS CITY& TATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ` / ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ VL V
DESCRIBE
WORK
7�yd n
/ -7 >e
BEDROOMS 2 DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED 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
TOTAL SQ.FT. 960 FI REPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT XZ SHORELINE
SEASONAL
OWNERS AF DAVIT CONTRACTORS AFFIDAVIT
I CERTIFY T T I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
CERTIFY
LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREM TS 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 CONE MANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININ AP.PR�jOVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X O ER y��^ lei Lclis DATE /' 9 X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION �Jd
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT 195 a
D.O.T. BUILDING 40K PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP -3 PRE-INSPECTION
SHORELINE
O '- 4� 0 )rioUhl WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE S
STATESURCHARGE
APPLIC ON ACCEPTED BY PLANS CHECK BY APPROVED,FOR ISSUANCE PERMIT VALIDATION
�; BY . ASH CK MO TOTAL
PLOT PLAN
ADDRESS E 3�Z I �- _ PERMIT NO to
s •
I 1
e
LEGAL D4
DESCRIPTION (�f LOT BLK ADDITION }\
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 23 Z 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 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. 1�
1+1
® INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
1
l
I I
I/We certify that the proposed constr on will conform tot the dimensions and uses sh/own,*ova nd that no changes will be made without
first obtaining approval. /i j1� � I�� ,� �` I`
NAM M OF OWNER(S) OF SITE 6 STRUC UREISI (PRINT) IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED I
DISTRICT AS NOTED DATE
[✓l Building Permit -
[ Plot Plan
[ ] Plumbing-Mechanical (If Needed)
t. 1= Heat.Loss Calculation (If Needed)
Blue Prints (To include-Cross Section)
t . Septic System Records
Mobile I.O. Form .
[ ] Pre-inspection Fee ($25.00)
[ ] Shoreli a Exemption
Received by Time ' Date
Initials He lth Exempt
Initials Planning' Exempt
Use Reverse for Directions and Mao to Job Site