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Home My WebLink AboutBLD26615 Mobile Home - BLD Permit / Conditions - 8/31/1990 3 �) 1 L a . o0o VC) Shorelines: Plumbing: Setback: Mechanical: Special Interior: Conditions: FINAL: Mobile Home: Smoke Detector: Remarks: Footing: Setback: Foundation Walls: Framing: Fireplace: Wood Stove: TYPE MnRTI F HnMF Permit No. 2E)69 5 No. Floors Sq Ftg Owner M RAC, rAl \/TNI E Tel Date $_� _90 Address Pn Rnx 74a ggAltnn Zip -- 4� Contractor nnnP Address Zip Legal Description �4-21-3 Tr 1 NWI N.lg Direction to project site HwV � t n Maenn I k Rri tern I- go 1 .9 miles Qost with address on rights Side of Rd Plumbing ec anica Sewer Wood Stove Fireplace Deck arage arport Basement —Loft Other XX i BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE 9 q SI DIRECTIONS TO JOB SITEHLUS4 -iACVI , Se 1 f N PARCEL EGA=R. r t t NUMBER DESC T NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR USE OF BUILDING r n a Mq, / 9 73 yy x ;Y gatiA✓ 13 AOe6c CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK fn 0 ver 6 BEDROOMS DECKS Y OR N - CARPORT NOTICE TOTAL SO.FT. DECK - GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SO.FT. TOTAL SQ.FT. CONDITIONING. NO.OF STORIES BASEMENT Y O N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT) FIREPLACE ATTACHED f SEASONAL SHORELINE _ DETACHED Y S AFFIDAVIT CONTRACTORS AFFIDAVIT THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF TION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE ENTS 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 ORMANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING G APPROVAL FROM THE BUILDING DEPARTMENT. Q APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER Cr Ad-L r J'1 G MOpTE �?'�=LSL_ X BY __ DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION (/ YES NO YES NO , HEALTH 4-2j(-y0 PUBLICWORKS FEE PLANNING lvb- FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP .3 PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPR D FOR ISSUANCE PERMIT VALIDATION BY ^��D CASH CK MO TOTAL �` �5 BUILDING PERMIT APPLICATION MASON COUNTY t DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER I , `?g � c ( jt A C 'S� , Y �. DIRECTIONS TO JOB SITE C i' PARCEL LEGAL NUMBER n 0 DESCR. 'r fj� Lz I ), 1 NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR USE OF BUILDING CLASS OF NEW ADDITION TALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE _ WORK 4), r Y ' Yl 54 ` 1.a ac 1 • cehcL BEDROOMS DECKS YOR N CARPORT NOTICE TOTAL SO.FT. DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. TOTAL SQ.FT. CONDITIONING. NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT FIREPLACE ATTACHED SEASONAL SHORELINE DETACHED OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. C� APPROVAL FROM THE BUILDING DEPARTMENT. X OWNER C A L-'J A 6 hDn"l-NDATE9 "`'� % n X BY DATE FOR OFFICE USE ONLY DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL BY CASH CK MO PLOT PLAN ADDRESS k-, 19 n GS �I1 �. G�(g �aC PERMIT N0. o = s w 1 � OO LEGAL ' DESCRIPTION LOT BILK ADDITION ,� T N+�14' rY�� SITE AREA �(�r�� n 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. E- INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' { 5 0 T. n v � � / >x W P fin 1 o �1 0 3 fz�W 9 I �L Q l 0 O F T. I/We certify that the proposed construction will conform to the dimensiOhs and uses shown above and that no changes will be made without first obtaining approval. 1 NAME(S) OF OWNER(S) OF SITE \ STRUCTUREIS) (PRINT) 11IGNATURIE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVE -1� DATE DISTRICT AS NOTED 1S'Zff 1 aI 3 Irf I o � D & E Septic Svc. Inc. 7766 P. 0. 6cx 1247 Shelton, 1"/A 9$534 C�VS,TOMER'S OROER NO. OEPF. DATE ` --T 77-- 1361 1 NAME / l�15) / ` ',/ ,/HIV ADORESS L sofa•r usne.o.o. cwwwcE on ACCT. MOfEAE�.I ♦w.o oar 1 n� i 2 3� �Fj Z a! 51 b 110 -- .11 -- 12 fv 13 ---- 141 r 115" I - - 16 t -- 17 / -- 1181 REC'O BY FtMFCRM KEEP THIS SLIP' 5023/01320 FOR REFERENCE