HomeMy WebLinkAboutBLD N/A Mobile Storage - BLD Application - 6/19/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED p` .�—
PERMIT NO.
NAME MAILADDRESS CITY SSTATE ZIP PHONE
OWNER 5 as'
DIRECTIONS TOJOBSITE NO t T_Lt f �A-- -4O TAUWA BELFAR
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PARCEL EGAL
NUMBER --(- D SCR. t 5 n L_ _
CONTRACTOR NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
USE OF
BUILDING
CLASS
WORK O✓ NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE a ��� I ` I C
WORK T
P - /q
rn
REA: NUMBER OF: PLEASE INDIC NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR I
REST SgFt STORIES S LINE O CONDITIONING.
BASEMENT BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR 1
DECKS SgFt BA SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT FIREPLACE ARPORT/GARAGE
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SgFt ATTACHE ACHED❑ (�
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OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT 1 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 O
OBTAINING APPROVAL
(�FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
OWNER �-'u�- DATE" 1 X BY DATE
FOR OFFICE USE ONLY
APPROVED PR
`1
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION
HEALTH PUBLIC WORKS FEE p
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
THIS PERMIT ISSUED AS A TEMPORARY STORAGE PERMIT ONLY. SHORELINE
NO OCCUPANCY AT ANY TIME AND THE MOBILE IS NOT TO BE HOOKED WOODSTOVE
UP TO ANY UTILITIES OR PLACED ON FOUNDATION PLUMBING
THIS PERMIT MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY [PLANS CHECK BY APPR E F 14SUA CE PERMIT VALIDATION
TOTAL
�(_�! BY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 OAT-m iSSUEa
PERMIT NO.
NAME MAiL AOORESS CITY&STATE ZIP PHONE
OWNER R- 1 1 L 9S5-`8
OIAECTIONS
TO JOB SITE I QD, NAKF— T— T Ze-L i p-
1 MAKG LF1- 7-v,3 -rh Cote s n)5 r_I- LAE7 House- MAKE RT V-OLLOu) 9b 'TO FNI? L 21 r L/`4F,
PARCEL . LEGAL
I N
NUMBER OESCR. E
+ C O I }c I i+ I<.
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Indicate below: O Property lines and dimensions. Q
O Easements and roads.
O Septic, drainfield and reserve are or sewer. 70
p a
Septic t n r infi I m O Sep c tank a and d a e d setback distances from foundations.
O Location of proposed construction on property.
0 O Building & septic system setback distances from all property lines & easements.
Indicate North O 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. z
O Indicate topography profile of property and structure on reverse side.
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/we certiF/;1dt:ht prJpJ52d cor.sYUcncn w l:Jon.!Jrn to 'h�dir.,@^.lions and uses s`Jwn abo�a and'hat no cha,^games hill be.-nade xitlou',tics:obtaining aporoval.
TOPOGRAPHY PROFILE OF PROPER TY AND LOCATION OF STRUCTURE
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