HomeMy WebLinkAboutBLD22324 Final Mobile Home - BLD Permit / Conditions - 9/20/1988 IIX
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATEISSUED- `
PERMIT NO. 42fc24
OWNER NAME MAILADDRESS CITY SSTATE ZIP PHONE
DIRECTIONS ,
TO JOB SITE
17713
PARCEL LEGAL
NUMBER Z bow' 'OF DESCR. T� Z� � S /V
5W '� /� yZ IV60 SCC 2c7-as-1
CONTRACTOR NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
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CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK
l
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SQ.FT. r GARAGE SEPARCONDIATE
PE.MITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
NO.OF STORI ES AP— 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 SO.FT.j�W FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
i
I CE rrIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I 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
REOI IREMENTS 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
OBT NING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
NER-1 --�c-
'L?ATE =6 'g8 X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES No YES No BUILDING VALUATION _41
.
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING Ak PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
o T D /�I✓� -gyp 4 l�ri SHORELINE
.-r WOODSTOVE
r L 1"GLh PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK ION
/BY APPROVED FOR ISSUANCE PERMIT VALIDAT
IV /C BY � CASH CK MO TOTAL �� ��
PLOT PLAN
ADDRESS 7 3 14 uV y S . S?_ "PERMIT NO.
TR 27 a}` 5%z S w '1 Al )'Z �JW Sec° . 29
LEGAL
s
w
DESCRIPTION LOT BLK ADDITION
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
• r
INSTRUCTIONS TO APPLICANT W
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE No
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) M.
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF E
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'
1 .
TU
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3 �
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* Q obi 4/
ell
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I/We certify that the proposed construction will conform to the dimaraiotst and asses shown above and that no changes will be made without
first obtaining approval.
R a_ c - er-t4es
NAME(S) OF OWNER(S) OF SITE S STRUCTUREIS) (PRINT) SIGNATURE OFOWNER(S) OR ALITHORIZZO REPRESENTATIVE
Do NOT WRITE BELOW TN/S LINE
APPROVED
DISTRICT AS NOTED DATE
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector: ove4t1ir
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 22324 No. Floors Sq Ftg 1320
Owner CRITES, Rick E Tel 275-4840 Date 7-13-88
Address P 0 Box 793 Allyn Zip
Contractor None
Address Zip
Legal Description Tr 27 S-1 29-22-1
Direction to project site E 177 3 Hwy 3
1 mile 3: asuk[ South of Allyn Center of Hwy 3
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1973 24x55 2 bdrm
I