HomeMy WebLinkAboutBLD16088 Final Mobile Home - BLD Permit / Conditions - 1/29/1985 j� WILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. (O6
OWNER NAME MAIL ADDRESS CITY STATE STATE ZIP PHONE
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DIRECTIONS /
TO JOB SITE ��� �yf & Al O,(/ �,W 3,
LEGAL /dr Q- /4uo, /-4"C >� yo9yy9 )y,>o eo- ,f.FG', /7' (❑ SEE ATTACHED SHEET)
DESCR. G'r, / 'V,zV,.4f'
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
o✓ f At o Bi o m vro #rkP D yd 1 1�60
Valuation of work: $ PLAN CHECK FEE PERMIT FE
0v0. CEO 0.oZ
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. 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 State of Washington and I th 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 LF/
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT ALTH DE . 3
ORKS
I certify that I a xempt from the requirements of the FIRE MARSHAL
contract or reg' tration law RCW 18.27, and am aware BUILDING DEPT.
of the Mas County ordinance requirements for
which this rmit is issued and th t all work done will ROAD ACCESS
n con rmanc ther 'th. 1 MOTOR VEHICLE PERMIT
97 APP (CATION ACC TED BY PLANS CHECK BY APPROVED FOR ISSUANCE
ner / Date! p BY
PLAN C CK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
ter. PLOT PLAN
ADDRESS �i _1 9� ��/ �� J. ���Y�(/� LUT i , PERMIT NO. o
z
LEGAL T / Il�• F1,4f d �9 Y 9 •lt gfaN `O ' °o
a
DESCRIPTION LOT / BLK ADDITION
a
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"=20'
I-T_ G
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L
5 � e
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o - a
I/We certify that the proposed construction will conform to tM dlrtMrnitlnt and uses shown above and that no changes will be made without
first obtaining approval.
JaHN kll, l`�IuRP�1/
NAME(a) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) - IGNATU OF OWNERS) OR AUTHO I ED P ENTATIVE
DO NOT wR/TE BELOW T VNE
APPROVED
DISTRICT AS NOTED DATE
SHRLTON Pn?NTINO
Murphy, JOhn W. #16088
644-1348, Bellevue 9/7/84
17-22-1, Lot B
1.5 miles north of Allyn on Highway 3
Mobile Home No Contractor
101x401 , 1960, 1 bedroom
$2,000.00
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