HomeMy WebLinkAboutBLD11152 Final Mobile Home - BLD Permit / Conditions - 6/30/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
u PERMIT NO.
�IL ADDBC7SS CITY&STATE _ ZIP PHONE
OWNER G� �� �S 19
DIRECTIONS / J 1
TO JOB SITE /, f��<� /�!I� �c� hU Za r-f�`�-a �l �J��'c fZ/ .4<f iS M /c�G� ,�E� 4L
LEGAL (❑ / ✓
SEE ATTACHED SHEEA�,.t
DESCR. /
NAME MAIL ADDRESS CITY S S TE LICENSE NO. PHONE
CONTRACTOR J y �,-
21
b v
USE OF /
BUILDING �� J
Class of work: ❑ NEW ❑/ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe ork:
rt�Ci fi s Le
0C)
Valuation of work: $ rfv PLAN CHECK FEE PERMIT FEE
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 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 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 therewittham./ PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
Firm /Tl,h7 �/
E.D. NO. S.E.P.A. ❑
By Q Special Approvals IN OUT YES APPROVED NO
Lic. No._ Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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
.6f the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in cc forman ,therewith. MOTOR VEHICLE PERMIT
PPLIC TI N EPTED BY PLANS CHECK BY APPRD FOB ISSUA CE
Ow er _ D to. BY
,a
M.O. CASH
PLA�}t --.CHE K VALIDATIO CK. M.O. CASH PERMIT VALIDATION CK.
PLOT PLAN
ADDRESS ./ &t-V4 V PERMIT NO. 0 o
s v
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS_ 2 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
rq
� r
r
I/We certify that the proposed construction wqmnfo the dimensi and uses show ova and that no changes will be made without
first obtaining approval.
NAMES) OF OWNER OF SITE III STRUCTURE(S) (PRINT) IGN TORE OF OWNER( OR AUTHORIZED REPRESEN TATIV
14
DO NOT WRITE ELO THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HEL.TON PRINTING
CATRON, S. F. #11152
Box 37, Allyn 0804-81
Up Sand Hill Rd. to Larson Lake Blvd. to Larson Rd. ,
left, right on Marie Lane
Beards Cove, Lot 18, Div. 6
Mobile Home Contractor - Hurt Mobile Homes
$9,544.50
��
�,
c
w
d