HomeMy WebLinkAboutBLD N/A Cancelled Mobile Home - BLD Application - 7/13/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
�O 427-9670 DATE ISSUED
PERMIT NO.
ME MAILADDRESS CITY&STATE ZIP PHONE
OWNER �U jU !o,% Z-
DIRECTIONS
TO JOB SITE n berrqu a r
more, econ ID o.LL on
PARCEL L
NUMBER al3(o"'o2y' O D SCR. 0� Wy $>� q ofSEIr Ins N W yq 6'.Z.I-3
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING ksidencjL
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK p b ilL
BEDROOMS 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 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. G4 b FI REPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT _� SHORELINE
SEASONAL
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.
XOWNERrt�� DATE q1111 89 XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH k PUBLIC WORKS aes FEE
PLANNING FIRE BUILDING PERMIT
v
D.O.T. BUILDING GUf< PLAN CHECK yy' �-
SPECIAL CONDITIONS BUILDING GROUP 7 PRE-INSPECTION
SHORELINE
0 WOODSTOVE
` 44Y \ PLUMBING
4V6, MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY C///yt CASH CK MO TOTAL
y�
PLOT PLAN
ADDRESS ere, e Q d, PERMIT NO. 4 0
s o
0
LEGAL '
DESCRIPTION LOT BILK ADDITION
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 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
i
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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.
NAME(S) OF OWNER(3) OF SITE d STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP EIENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Courthouse Annex 3 426 !-J. Cedar
P.O. Box 186 Shelton, Washington 98584
(206) 427-9670
building environmental health maintenance landfill parks&recreation fair/convention center planning sewer&water
October 17, 1989
Richard Field
P. 0. Box 1341
Shelton, Washington 98584
Re: Building Permit for
Mobile Home
Dear Mr. Field:
Some time ago you made application through this office to
obtain a building permit. Please be advised the permit is
ready to be issued and can be called for at this time.
If you are unable to call in person, a check in the amount
of $ 49.00 can be sent to us and we will return your
permit by mail .
This permit becomes null and void if not called for within
180 days of the date of application.
We hope to hear from you soon.
Sincerely,
Evelyn Fuller
Receptionist
J