HomeMy WebLinkAboutBLD17491 Mobile Home - BLD Permit / Conditions - 6/6/1985 GRAVE, Dean #17491
6-6-85
Paradise Shore Estates Div. 2, Lot 9
19425 30th Ave SE Bothell 98012 481-6356
Contractor
Self
Mobile Home 1Ox55 2 bdrm.
$2,750.00
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED —
ra—,1)61 PERMIT NO.
NAME MAIL ADDRESS _ CITY&STATE k� )�)) ZI PHONE
OWNER 1�.P to ' St ?� t�f/� 012 _4
DIRECTIONS
TO JOB SITE
LEGAL �" �' (❑ SEE ATTACHED SHEET)
DESCR. 1OT '` iGvT /RG C D-t1- Rcer odi .� ki i CsAT ,�iy .0
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR S
USE OF
BUILDING 1Q C Q T f O pA �,NtTbl? Plh
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ R
Describe work:
-t. .r9 D .,
1961 a,l o i l e Home / 0 ` X
Valuation of work: P N CHEC EE P MIT FEE OZ
SPECIAL CONDITIONS:
.,
BEDROOMS 0
I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
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 cer ify that I am a Currently registered contractor in WORK IS COMMENCED.
the State of Washington and I am aware of the FOR OFFICE USE ONLY
or nance requirements regulating the work for which
th permit is issued and all work done will be in
c nformance therewith. PERMANENT SHORELINES'
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
KS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.; B
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. �! MOTOR VEHICLE PERMIT
Owner /�� ilr UBie. V APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
DA a YI 4 J&t G ya rx s PLOT PLAN
ADDRESS I%�1� 3a 7114 41✓ ,S &&e/1 LI&SI 2&A&ERMIT NO. 0 o
a o
LEGAL REP/*-r O
T
DESCRIPTION LOT 9 BLK15'ads 4(47ADDITION Pq#,d;f,.sL,, E5Ttrd a
�M
/✓iJ17.2 a
SITE AREA- 70/2 Sq.Ft. AREA OF SITE QCCUPIEO 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&ID 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. Q
L INDICATE NORTH IN CIRCLE / GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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 _
AME(SI OF�( ) OF SITE STRUCTURES) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
fHELTON PRINTING