HomeMy WebLinkAboutBLD30150 Mobile Home - BLD Application - 3/26/1992 BUILDING PERMIT APPLICATION
J MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASH ,� /,,
427-9670 /�✓ uATE ISSUED
`�'
PERMIT NO.
ME M ILA RESS CITY STATE ZIP PHONE
OWNER �, tr `_ Ir l
DIRECTIONS �10O
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PARCEL LEGAL
NUMBER DESCR. (� d �//• 3'• QLf!<<if?l 1. �-�K� � iiC"f�,NAVE MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES�_ SHORELINE❑ CONDITIONING.
BASEMENT SQFt BEDROOMS k RIMARY RESX THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS Ft BATHROOMS SEASONAL RES.0 COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 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 t" DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO s(.q
HEALTH PUBLIC WORKS "2- FEE
PLANNING FIRE MARSHAL BUILDING PERMIT aLJ 2S
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP I PRE-INSPECTION
T-Pi SHORELINE
v Z Vpc Aw,(xj v. WOODSTOVE
V��"f 'o-Co� w� L.a_ PLUMBING
r Q_ 3 )-b &- MECHANICAL
KrziS , Z 1pS � �S STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION />
a5f BY3 avol CASH CK MO TOTAL
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME AIL ADDR SS CITY&STAT ZIP PHONE
OWNER � r Vj Box .SO)3 _J�aj rZ /Loa 37,-127 (�
DIRECTIONS k4y—
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10
PARCEL �C LEGAL f -
NUMBER c DESCR. I--d,ke
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building& septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage.
O Attach copy of septic system as built or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
)� R o ►� �
MEOW No"
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I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will ben►edewlthout firsF6btaining approval.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE