HomeMy WebLinkAboutBLD9669 Mobile Home - BLD Permit / Conditions - 12/3/1979 VanBuskirk, Bill #9669
12-3-79
N 1/2 Nw 1/4 Ne 1/4 Se 1/4 16-21-2
Mason-Benson turn left go about 150' to dirt road
turn left right side. follow road to tr. 12
Mobile Home
i
- BUILDING PERMIT APPLICATION
M
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED col 1:7- ;�
PERMIT NO. '91ro o' y
OWNER NAM MAI ADDRESS CITY&STATE ZIP PHONE
c- fir - S
DIRECTIONS from SIEI oN qo to MWz,0j i~ £.Asojv . -ru.r 1'. 40 A-Bo«Y" i<0' TD Derr 12D. "furNl.EcT
TO JOB SITE GD Rt3ouT im mtll. to Stop StgN Turn �yr : to RBou 1 m►t£, tp nf,,, a l rt D, c>ti1
LEGAL t1 W'/4 , N A I/e S L I/4 , 1 I0 (❑SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE ae Er-d
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 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 ❑
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. Alp,?
PUBLIC WORKS
I 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 in conformance therewith. MOTOR VEHICLE PERMIT
1
i n AP LICATION ACCEPTED BY PLANS CHECK BY PROVED FOR ISSUANCE
Owne Date. C N
�t(- 0C=:=% 'a-
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
dh
ADDRESS D DX 26- i> G•r"t lle��j , Q5? <ZZ PERMIT NO. 4 0
= o
a a
0
LEGAL
DESCRIPTION LOT BLK ADDITION M
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'
own
a '
I/We certify that the proposed construction Will cpnform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
i`
NAMEM) OF OWNERS) OF SITE a STRUCTURE(S) (PRINT) SIGNATURE OP-OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING