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HomeMy WebLinkAboutBLD19213 Final Mobile Home - BLD Permit / Conditions - 10/2/1986 • BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 426-5593 DATE ISSUED'20 A PERMIT NO. /G C2 NAME a MAILADDRESS ITY&STATE ZIP PHONE OWNER . .47i 33 C ���4ilt L� _ 5za75 C //7 DIRECTIONS f _ _ TO JOB SITE �.fflzSC� ,N I fc �)2 ).A250o E00 Of i,4c �cvr\`) on LET I 5 /rJ i -73 LEGAL C C 2 r--� DESCR. J O � �, •� /v NAME MAIL ADDRESS ITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR USE OF BUILDING CLASS OF NEW tTION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORKbl�� c_ / e 1-2 7- BEDROOMS DECKS CARPORT SEPARATE PERMITS ARE R R—PtttMBtNG; tiE VENTILATING OR AIR BATHROOMS Z TOTAL SQ.FT. GARAGE CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULLAND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FORA PERIODOF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT <<zS SHORELINE SEASONAL ' OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS 1 CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE RE( JIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING O AINING APPROV4-0-z- L FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. OWNER DATE ��� XBY DATE FOR OFFICE USE ONLY DEPARTMENT YES NO NO DEPARTMENT YES NO BUILDING VALUATION 9 76 HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT 6 7 D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE PLANNING PLUMBING MECHANICAL STATE BUILDING FEE Q STATE SURCHARGE � APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL BY CASH CK MO ' PLOT PLAN ADDRESS 1`4 71 L AiLSON k co PERMIT NO. 0 0 i a 3c c . `2-3 1 30 ,E o 0 LEGAL DESCRIPTION LOT ? C. S BLK ADDITION " u SITE AREA <g 2© Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS 0'So 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 Al"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. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' ow w ry'lei N - R� 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. n � / t NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) IGNA I OF OWNER(SI OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE SHELTON PRINTING TYPE MOBILE HOME Rermit No. 19213 No. Floors 1 Sq Ftg 1020 Owner FRISBYI Sujin Tel 275-6117 Date 8-28-86 Address P. 0. Box 833 Belfair Zip Contractor Westan Hauline Tacoma Address Zip Legal Description RParrlc Coy,- Tn;'17 5, Tot 73 Direction to project site 1471 Larson Take Tan (or Larson T,ak Rd_ ( 3rd moh le from end of roaci on left Plumbing Mechanical Sewer Wood Stove Fireplace Deck Garage Carport Basement Loft Other 1986 28x40 2 bdrm. REPLACEMENT MOBILE Shorelines: /✓,� Plumbing: Setback: Mechanics . . Special Interior: Conditions: FINAL: gU Mobile Home: Smoke Detector: Remarks : Footing: Setback: Foundation Walls: Framing: Fireplace: Wood Stove: