HomeMy WebLinkAboutBLD26519 Final Mobile Home - BLD Permit / Conditions - 1/10/1991 3D'� I C�__) -- S
q . 10
Shorelines: Plumbing:
Setback: Mechanica :
Special Interior:
Conditions: FINAL: _ 1C���
Mobile Home:
Smoke Detect7r-QC1 t
F s�7B/�c�cs Remarks:
rooting:?.Ulu YjZ�1 Cf�_ �� ICI eT ,.,.,�-at�c,r�,►
Setback:
Foundation r �g -
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 2651 ) No. Floors
Ftg
Owner MILLER. ROB RT N. Tel � Dat
_ 426-8685Date
Address _14 W Harvard
Contractor ShAltnn Zip— �
Address Zip
Legal Description —1akP i mPri rk Pi v l nt nn
Direction to project site Lakelmarirk nt. 1 4
to Peebl e ylne ad
r IlPxt. 1 of from the rnrnpr
P Lm ing Mec anica Sewer Wood Stove
Fireplace Deck ZdQ Garage Carport
Basement —Loft Other ��
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED __ v
PERMIT NO. C6
NAME MAILADDRESS CITY 8 STATE ZIP PHONE
OWNER e V' .
DIRECTIONS ISG ✓
TO JOB SITE I-a n/fi e l� l e 4/ c G y p' f-C� �N9►/
Road -rc zPee 8/-k a L-t AP ZgL/�W' A�
PARCEL LEGAL / y
NUMBER ,320 DESCR. ,!0r �/ �(j , S !� Q
NAME MAIL ADDRESS CITY&STATE LICENSE NO ZIP PHOttt
CONTRACTOR ch, G 'S H0 C �- Z; �
USE OF C C1N /YG -d�rz �7aC'
BUILDING J (�( lijZ ill L �'�� l'Yl
CLASS OF NEW x ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK I
BEDROOMS 3 DECKS Y OR N CARPORT
TOTAL SO.FT. NOTICE
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. TOTAL SO.FT. CONDITIONING.
NO.OF STORIES / BASEMENT Y OR10 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT ? FIREPLACE _ ATTACHED
SEASONAL ? SHORELINE DETACHED
OWNERSAFFIDA T CONTRACTORS AFFIDAVIT
I CERTIFY THAT I M EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LA RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS R 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 CONFORMA E THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING AP OVAL FROM THE BUILDING DEPARTMENT. 1, APPROVAL FROM THE BUILDING DEPARTMENT.
X O E ATE �` a X BY DATE
FOR OFFICE USE ONLY /
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT
BUILDING VALUATION v
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT SV
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP ir-1 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE . son
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY A VED FO SUANCE PERMIT VALIDATION
�- BY CASH Cl MO TOTAL
PLOT PLAN
,I� j_. L /� -}� 4 u s_r c �' C/-19 L.Y""i e
ADDRESS `-' /'" "C l� �J S Co GL y ( PERMIT NO. f
0
z •
LEGAL
DESCRIPTION LOT �C� `7 BILK �i ADDITION ,LL?A(_� t-
C/
SITE AREA ) D 6DSq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS / L' 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 POW
TION THEREOF.
T
INDICATE NORTH IN CIRCLE •�i. G RA-PLl,�gd�;,�'�CO-�A-D�._c,�,w
1�
oe
� V
r Se
v
J �
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. ta
L.��%M OF OWNER(S) OF SITEa STRUCTURE(S) (PRINT) IGNATUR OF OWNER(SIAUT no on R P ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
T AS NOTED DATE