HomeMy WebLinkAboutBLD28912 Mobile Home - BLD Application - 8/27/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
AA
OWNER NA E MAILADDRESS CITY&STATE ZIP
CWILSA
DIRECTIONS ry ,& 6 �� / �,4�"tS t L
TO JOB SITE C _ah / /
PARCEL r� LEGAL U � f t� �� /
NUMBER V DESCR. w 6
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
WORK DESCRIBE PiAc-r/jlvi oiz lttaAlzt-
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE laoSgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT qFt BEDROOMS PRIMARY RE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKSLJ7 -�S Ft BATHROOMS SEASONAL RES.0 COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE n Y SgFt ATTACHED O DETACHEDX
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 BUILDI G DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNE ATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
APPROVEDNO DEPARTMENT YES DEPARTMENTBUILDING VALUATION C�
HEALTH PUBLIC WORKS FEE �•
PLANNING FIRE MARSHAL BUILDING PERMIT L
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
4-12 SHORELINE
WOODSTOVE
If
PLUMBING
MECHANICAL
STATE BUILDING FEE L �,
APPLICATION ACCEPTED BY PLANS CHECK BY APP VED ISS A E PERMIT VALIDATION /
TOTAL
�� B '�� ASH CK MO �
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY b STATE ZIP
OWNER IS ,AA/ 61cs:�'
DIRECTIONS ++II A' // � r J/� �/�
TO JOB SITE U,/V 44kk- (JYT/ b� `i'L ✓ / � �`� / 5 `�
rPVUMBER �� Iz oEsca. zoT 1)D ��.%V LA b'
Indicate below: Q roperty lines and dimensions.
O asements and roads.
b eptic, drainfield and reserve area, or sewer.
eptic tank and drainfield setback distances from foundations.
ocation of proposed construction on property.
Building 3 septic system setback distances from all property lines & easements.
Indicate North ,0 Well and water line.
'O Saltwater lakes, rivers, streams, wetlands, drainage.
In Circle O Attach copy of septic system "as built" or septic permit-approval.
O Indicate topography profile of property and structure on reverse side.
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I/we certify that the proposed con,struc;ion wii,conform to the dimens,ons and uses shown above and that no changes wilt be made without first obtaining approval.
SiG,v>TURE 0=Ow,NER1Si OR AUTH0RjZ=_0 RE??E3E147A7ivE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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