HomeMy WebLinkAboutBLD12947 Final Mobile Home - BLD Permit / Conditions - 4/14/1983 BUILDING PERMIT-APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED � j O
PERMIT NO. /c)2 7
OWNER NAME MAIL ADDRESS CITY 3¢TATE ZIP PHONE
e m A Z 3 w WA, .27Y=33s'0
DIRECTIONS
TO JOB SITE C e e /1/ T"S t C e e
LEGAL (O SEE ATTACHED SHEET)
DESCR. She Rw o o d , #,k - D I V. 1 - L aT- 1 Sc c, 3 b WAI, 2 - R1 W
CONTRACTOR NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
USE OF /� /�
BUILDING Reg P Ae 14 cC / Y/ ,x (/ (/ t �q Is- cok1 Al 77�4-4 ltl0dix1jve
Class of work: X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ a PLAN CHECK FEE PERMIT FEW
SPECIAL CONDITIONS:
!s. r
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
NO. OF STORIES BASEMENT ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT.IM FIREPLACE ElDETACHED ❑
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 the
aware of the F R 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
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 HEALTH DEPT.
PUBLIC WORKS
1 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 conformance therewith. MOTOR VEHICLE PERMIT
/j LIGATION PTED BY PLANS HECK BY APPROVED FOR ISSUANCE
Owner Date �� '�� BY ,
oL CHECK VALIDATION CK. M.O. CASH UPERMIT VALIDATION CK. M.O. CASH
Miller, Herman #12947
275-3358 �x /l/882 #
Sherkn5od Park, Division 1, Lot 1, 30-22-1 r, '3�g`1-
1 mile up Sherwood Creek, northside on Creek, Allyn!,"
Mobile Home Contractor;
14'x60' , 1975 Self
$10,500.00 Shoreline Exemption
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