HomeMy WebLinkAboutBLD13524 Move Mobile Home - BLD Application - 1/20/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 /-a Q r-Y3
DATE ISSUED
oZo13A5 50 - 0a0o3 PERMIT NO. 13,
NAME MAIL ADDRE CITY 8 STfATE ZIP PHONE
OWNER l�c�/�a ci �J -��
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. %3 V 4 30 —a 3 — 1
CONTRACTOR E / MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
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USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
141 o
Valuation of work: P$ �O PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS- {DECKS 99 CARPORY NOTICE
BATHROOMS _ I TOTAL SO. FT. GARAGE
ATTACHED i' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [ ] OR AIR CONDITIONING.
TOTAL SO. FT.-fO 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 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 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 I
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SEASONAL i FLOODPLAIN i i
Firm E.D. NO. S.E.P.A. f_,
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. �foj
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
of the Mason County ordinance requirements for BUILDING DEPT. / q7 J
which this permit is issued and that all work done will ROAD ACCESS
7_77-
for "ante ere MOTOR VEHICLE PERMIT
�O � A LIGATION EPyED BY PLANS CHECK BY APPROVED FOR ISSUANCE
w - Date. U e
PLV CHECK VALIDATION CK. M.O. CASH RMIT VALIDATION CK M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. f o
a o
LEGAL J
DESCRIPTION �LOT Z 4- BILK ADDITION U
SITE AREA 2 Z'>� 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'
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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 be made without
first obtaining approval.
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NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(SI OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED _
DISTRICT AS NOTED 'f% �, DATE
&MELTON PRTNTIN0