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Home My WebLink AboutBLD13275 Mobile Home - BLD Permit / Conditions - 11/15/1982 Hurley, Kevin J. #13275 426-4251 11/15/82 S 1/2, W' 1/2, W 1/2, SW 1/4, NE 1/4, 18-20-4 West 6 miles on Matlock Dayton Road, turn left on Highland Road, 600 feet on left. Mobile Home Contractor: 1970, 12x48 None Listed $7,200.00 Shorelines: Setback: Special Conditions: Footing: Setback: Foundation Walls:— Framing: Fireplace• Wood Stove: P lu mbing: Mechanical: Roof: Exterior: Interior• Final: Stop I br : Mobile Home: Smoke Detector: Remarks: ;q 1/ 4Z.Om !b . r r BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED PERMIT NO. /3-2) 7zr OWNER NAME 1 MAIL ADDRESS CITY&STATE PHONE r DIRECTIONS T ,,n 44 TO JOB SITE _ S I U�4 - (�'/J �cn LEGAL , ' ( t (❑ SEE ATTACHED SHEET) ��"`��"` DESCR. ` I CONTRACTOR NAME MAIL AD RESS CITY 8 STATE LICENSE NO. PH NE USE OF BUILDING ba., Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR >rMOVE ❑ REMOVE Describe work: S , , - -ynoo Valuation of work: $ PLAN CHECK FEE PERMIT FEE O3`/ 00.0 0as SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT G NOTICE BATHROOMS TOTAL SQ. FT. GARAGE : SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES. BASEMENT i ! ATTACHED I i OR AIR CONDITIONING. TOTAL SO. FT.%IL7-jk2 FIREPLACE Cj DETACHED Li 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 FO OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT IV SHORELINES SEASONAL t i FLOODPLAIN I_] Firm E.D. NO. S.E.P.A. I By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS 000 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. 2 which this permit is issued and that all work done will ROAD ACCESS Of Of be in conformance t erewi . MOTOR VEHICLE PERMIT oo, �/C AP LIGATION ACCE�T6D BY PLANS CHECK BY APPROVED FOR ISSUANCE Owner Date. c� P CHECK VALIDATION CK. M.O. CASH ftRMIT VALIDATION 6V M.O. CASH • PLOT PLAN r ADDRESS J�I I �T --�`1 LA N I/ �L � PERMIT NO. 4 D OO LEGAL DESCRIPTION LOT BILK ADDITION U SITE AREA 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. 0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=2041 L7 4� I/We certify that the proposed construction will conform to the dimensions and uses shown bo a and that no changes will be made without first obtaining approval. NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) IGNATURE OF OWNERIS) OR AU H TORIZED REPRESENTA 7IVE DO NOT WRITE BELOW THIS LINE APPROVED // DISTRICT AS NO $ DATE GHELTON f ;N-1N i SITE NO. 'r MASPN COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY r , , ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPT NUMBER 428 WEST BIRCH STREET • SHELTON, WA. 98584 PHONE (206) 426-5561 APPLICANT SIGNATURE I ADDRESS PHONE -- _- _ - -- _ NOT SITE: APPROVED El NOT PROPERTY OWNER BY: ADDRESS PHONE DESIGNED SYSTEM REQUIRED SEWAGE SEWAGE NOT CONTRACTOR DESIGNER SEWAGE: ❑ APPROVED ❑ APPROVED LEGAL DESCRIPTION BY: SOIL TYPE TYPE OF NO. OF LOT BUILDING BEDROOMS SIZE X DEPTH TO WATER TABLE PERC. RATE SINGLE RESIDENCE Q PUBLIC WATER ❑ NAME SEPTIC TANKS GAL, WATER SYSTEM SYSTEM ( ) PUMP REQ. COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL FEET DIRECTIONS TO SITE: FILTRATION AREA SQ. FEET QUANTITY OF APPROVED STONE-CU. YD. SAND-CU. YD. FILL REQUIRED CU. YDS. FINAL INSPECTION REQUIRED BEFORE BACKFILLING FDEPTH OF BACKFILL OR PAPER STONE PIPE SIZE STONE SITE PLAN AND SPECIAL STIPULATIONS UNDER TILE (INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH W f , i COMMENTS: THIS SITE PERMIT EXPIRES PLOT PLAN ADDRESS PERMIT NO. 0 o i o n > a o LEGAL a DESCRIPTION LOT BLK ADDITION u SITE AREA 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 Al"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. S APT Icw�wE� R� INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' SE PT C- 1� 2q 0 L 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. NAME($) OF OWNER($) OF SITE ! STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE &HrLTON PRINTINi