HomeMy WebLinkAboutBLD18151 Mobile Home, Mechanical, Storage - BLD Application - 11/19/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 '
DATE ISSUED
PERMIT NO.
OWNER1.4-)0
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE S� LP L� J h ! C( T✓L� Ci
LEGAL / // (❑ SEE ATTACHED SHEET)
DESCR. t27e,0,'7 /lQ-�� �../ / �- S
ME - MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR el /�F ✓�Gl
USE OF
BUILDING j-)G
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR 411f,91W ❑ REMOVE
Describ work:
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TQT Gl�'L�`ICc r
Valuation of work: $�� �/ `OD PLAN CHECK FEE PERMIT FEE_
OC Co ,S/,
SPECIAL CONDITIONS: O
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED 11
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 State of Washington and I rn aware of the FOR F F I C E USE ONLY
ordinance requir% ents regulating the work for which
the permit is 'Asued and all work done will be in
conformance erewith. PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT 7&ir!-7
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 in conformance therewith.
G MOTOR VEHICLE PERMIT
\1 )[�'✓ZdJGC( n"��-.Date. ///y Sf APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner -
PLAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING
PLOT PLAN
ADDRESS PERMIT NO. o a
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z
In D
LEGAL : a
DESCRIPTION LOT 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 A"ID 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.
' INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
7y
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(S) OF SITE 6 STRUCTURE(S) (PRINT) 11IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
CHRISTMASTOWN PRINTING