HomeMy WebLinkAboutBLD13771 Mobile Home - BLD Application - 3/28/1983 y BUILDING PERMI-T APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. / 3 7 4-
OWNER N ME MAIL ADDRES� CITY&STAN ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL / (❑ SEE ATTACHED SHEET)
DESCR. oT/ L,d C� 3 h V �^ L' O�C'0a/y1
NAME MAIL ADDRESS CI 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: y rnrn
Valuation of work: $ PLAN CHECK FEE PERMIT FE !
Q "
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT Ll NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE [I
ATTACHED I! SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT Li OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE I_I DETACHED L]
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 FORA 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 FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
Conformance therewith. PERMANENT SHORELINES n
SEASONAL Ll FLOODPLAIN
Firm E.D. NO. S.E.P.A. II
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT EALTH DEPT. >«Inj93g
PUB RKS
1 certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be ' conformance therewith. MOTOR VEHICLE PERMIT
7 A�..Q3 LIGATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE♦
O er --- Date .
PLA CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS 'j,' �x �UL� 'J`F'�. // 6LJ ��� �llS� PERMIT NO. 0 a
LEGAL
a o
DESCRIPTION 5 LOT BLK `�j ADDITION
SITE AREA L = 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 P"'D 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'
t
�v o
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) SIGNATURE OF OWNER($) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHELTON PRINTINi