HomeMy WebLinkAboutBLD27716 Move and Set Up Mobile Home - BLD Application - 7/16/1991I
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
NiJ�t� Q��a PERMIT NO.
N ME MAILADDRESS CITY& AT ZIP PHONE
OWNER E 4 M " byiA �Ane r
DIRECTIONS ,/� LL R �p ��► �� C D 'r S
TO JOB SITE N , t f. Rt'Ao J a a-CWA' ����� �Q� 5U Si� rr, l� -Fo /
�� S({nSr SSA �� SR Q 6f /At} ma o O h fl n2
PARCEL �I I LEGAL qq L
NUMBER D S DESCR. L-0 r 3S �l ✓l 51.0 �`� 0� /t Y s z'q 1�
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING
CLASSOF NEW ADDITION ALTERATION REPAIR MOVE X REMOVE
WORK ✓ /�
DESCRIBE
WORK m y t 5S mAd o M Q_j
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SS 0 SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED O DETACHED❑
OWNERSAFFIDAVIT 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. ^� q APPROVAL FROM THE BUILDING DEPARTMENT,
X OWNER & � ATE X BY- - DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION F
YES NO YES NO V
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMITit B
J
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
7' WOODSTOVE
I I PLUMBING
Vt
MECHANICAL
�� - \ t 7 ✓y STATE BUILDING FEE ,5
APPLICATION ACCEPTED BY PLANS CHECK BY APP VE /R ISSUANCE PERMIT VALIDATION `�
= II el B ,4/ ASH CK Mo ITOTAL
C
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON WASHINGTON 98584
� Q
-7
4 2, 9670 oar IssuEo
O ®� PERMIT NO.
NAM At A Cl d A E Zip PHONE•
OWNER �u� 0. 8 - - & . 9�5a K
OIPECTIONS
TO ice SITE - (Z i=A R - ( k T T L--F R
1 Or-
PARCEL � LEGAL
NUMBER I W3
t.51000351 OESCR. I I-O'T 3S bi 0is10rJ ZI C.nkk 1 NS Lpw-g
Indicate below: O Property lines and dimensions. 'd
O Easements and roads.
O Septic, drainfield and reserve area, or sewer. M
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.0 �I
Indicate North O Welland waterline. _ m
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. z
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/we cgrvFj corst/Jcnan W%zCn(oY.1 tC and uses s`.'wn abova a :fat no Clivvs'milt be made obtaining aocraval.
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TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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