HomeMy WebLinkAboutBLD16753 Mobile Home - BLD Permit / Conditions - 4/29/1985 a
it
,DAY, David W. #16753
4-29-85
Tract 5 of NW-1/4, NW-1/4 32-21-3
E 953 Jensen Rd. Shelton 426-0862
Jensen Rd. then left then left then right.
Contractor
Mobile Home 48x28 1985 3 bdrm. None listed
R $24,864.00 3 a1 5� - - � -
7d v� cn hi H N 7d ro E �4 114 Ki M "d cn cn m
mp0 .rtwp Moms-A0wti0mo Timms
0 C0 p rt rt 0 n G 0 ti w G rt 0 m rt o
v w m m F-nxp am q m v' rt 7r ►w n
ti m es ti ti •• w cr "0 waw w ww m
K m •• w w 0 w cn N G w n G w n r
0 d 0 0 0 0 rt w ov rt W OQ ac' F+•
.. rt o x ti ti °° c m •• o .. � ..
m
m m 0 0
n m a.
rt
o rt
ti
� w
w
i
�M
c
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �y��
DATE ISSUED
PERMIT NO. & zcz
OWNER NAME MAIL AM CI STATE PHONE
DIRECTIONS
TO JOB SITE W, `-� ✓�-
LEGAL (❑/SEE
\ATT�ACHED SHEET)
DESCR.,/(� ,5 of'
I V "� 6 y &wYq +-q - � 6- V
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: 15QNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR El MOVE ❑ REMOVE
Describe work: ✓
60 kl�
Valuation of work: $ Q� i/ PLAN CHECK FEE PE9pA FrE
SPECIAL CONDITIONS: p�
BEDROOMS DECKS CARPORT❑ NOTICE
BATHROOMS TOTAL SQ. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORI S� ATTACHED ❑BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FIREPLACE ❑ DETACHED ❑
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 fate of Washington and I am aware of the FOR OFFICE USE ONLY
ordi ance requirements regulating the work for which
the permit is issued and all work done will be in
co formance therewith. PERMANENTX SHORELINES)l
SEASONAL ElFLOODPLAIN ElFirm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
ZONING
Lic. No. Date
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. t►��.s.�PUBLIC WORKS
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 i onformance th r 'th. MOTOR VEHICLE PERMIT
S/r^ APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner ate
PLAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
nu DiDrue MAIKu DDIMnMr-