HomeMy WebLinkAboutBLD21156 Mobile Home Space 20 - BLD Permit / Conditions - 11/4/1987 jg( _ a�7
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile
Smoke Detector:
Remarks:
ootinngg
Setback:
Foundation
Walls: PERMIT
Framing: ` ...1.. B�r E..,�In '�iOi�i
Fireplace: L .
Wood Stave: t.w,re t_Y-9� BY
TYPE MOBILE HOME
Permit No. 21156 No. Floors Sq Ftg 714
Owner DEMI K, arm J Tel 275-3120 Date 11-4-87
Address 3760 S Mission R W Bremerton Zip
Contractor None
Address Zip
Legal Description Town of Allyn Lot 91
Direction to proje S1 a Sherwood Hills R_ V_ Park
Space #20 Log 1Home
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1987 14x51 1 bdrm
PLOT PLAN
ADDRESS 4b IN A PERMIT NO.
" s
s
LEGAL "
DESCRIPTION LOT 8LK ADDITION
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 AND 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
r
0_
I/We certify that the proposed construction will conform to tha dlmenaiOhs and uses sh nd t at no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE a STRUCTU (s) (PRINT) SIGNATURK OFOWNER(S) OR AUTHORIZED REPRESENTATIVIE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
BUILDING PERRMT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED Z/.//-,,,-,f 7
3r7(oa PERMIT NO.Cx Z.--f 5/2
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER HI E DEmlr-K AL-L"N WASR, 275-31Zo
DIRECTIONS SPgCE #0t, 2
TO JOB SITE Q A 4t-: T (A)gELLW81COO 511, L6G #00f4
tool
PARCEL LEGAL
NUMBER�� � DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
WORK r CLASS OF NEW ADDITION ALTERATION REPAIR [MOVE REMOVE
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED 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
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEA ONAL
OW ERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CE IFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT 1 AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI TRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ REMENTS 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
O TA NING APPROVAL FR M HE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
LX O NE //ZZ `� DATE -Z'S- g� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVE NO DEPARTMENT YES
PPROVENQ BUILDING VALUATION Q
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
`� SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE ,
APPLICATION ACCEPTED BY PLANSCHF.QKBY APPROVED FOR 1 ANCE PERMIT VALIDATION
BYgQl� CASH CK MO TOTAL �5