HomeMy WebLinkAboutBLD4572 Mobile Home - BLD Permit / Conditions - 4/30/1979 Carey, Charles E. #4572
4-30-79
Lot 3 18-20-4
West out of Shelton on Matlock Road lst driveway
past Panhandle Lake Road, near Blue house
Mobile Home
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED ' -�� 7 y
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
All
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DIRECTIONS
TO JOB SITE WFrST our 7e V'Al Affirl-vA157 ORItlfwA.y PAS f'/9N AN
LEGAL 9 (❑SEE ATTACHED SHEET)
DESCR. SEC jr/0
TO WA-SN /p 20 N RAND Y /EST ,3
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR
l Q VA Ll 7'y HeAjCSC . o0
USE OF
BUILDING
Class of work: )( NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
L I cc AlD aMF' 0A1 RAtpiwry FoA YEAn Re,,
RE St
Valuation of work: $ .2 3 PLAN CHECK FEE PERMIT FEE j 0
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT W NOTICE
BATHROOMS TOTAL SO. FT.1W GARAGE ❑
ATTACHED G1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT.—litD FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO.___(0_ S.E.P.A. ❑
By Special Approvals IN OUT
YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT
HEALTH DEPT. 7
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
��// be in nformance therewith. MOTOR VEHICLE PERMIT
OwfTer -'4 Date. A ICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Y
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
I
ADDRESS PERMIT NO. f o
o
LEGAL �SEGT/C�✓ / !v6u v-%H11- ,2C Ill
DESCRIPTION LOT BLK ADDITION u
SITE AREA1� 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"'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.
I
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.
NAMES) OF OWNERM OF SITE 3 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHELTON PRINTIN3