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HomeMy WebLinkAboutBLD15788 Mobile Home - BLD Application - 7/5/1984 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED PERMIT NO. X-5/QQ A E MAI ADDRESS CITY 8 STAT _ / /Ir: PHONE OWNER � � � ! o DIRECTIONS L E- UA�1 ,r.19 r V' �L-�[�14-) (J� TO JOB SITE S'�.�`^��'rVP1�� -�©Iloi�yk� U I�M1=14urJ� r A�ybL�n u " �= Q LEGAL �� jJ J m I I �� �l4 S E ACHED SHEET) DESCR. ' / V\ NAME MAIL ADDRESS CITY 8 STATE LIC NSE PHONE CONTRACTOR `_ USE OF yt 616— BUILDING �/// Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE Describe work: Valuation of work: $ �-, PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: BEDROOMS DECKS — CARPORT Ij NOTICE BATHROOMS TOTAL SO. FT. GARAGE I : SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT G ATTACHED : OR AIR CONDITIONING. TOTAL SO. F FIREPLACE 11 DETACHED Li 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 the aware of the FOP OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformanc erewith. PERMANENT SHORELINES SEASONAL LI FLOODPLAIN i Firm E.D. NO. S.E.P.A. L By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. 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 therewi . MOTOR VEHICLE PERMIT i A P CAT ACCEPTED BY PLANS CHECK BY PROVE FOR ISSUANCE Ow e PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS PERMIT NO. f o n D D OO LEGAL n DESCRIPTION LOT BLK ADDITION u 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. 0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' 1 I i I/We certify that the proposed construction will conform to the dimensiMs and uses shown above and that no changes will be made without first obtaining approval. NAMEIS) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE SHELTON PRTNTING