HomeMy WebLinkAboutBLD13555 Cancelled Mobile Home - BLD Permit / Conditions - 1/27/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 `
DATE ISSUED7/�'�
PERMIT NO.
OWNER 6,.NAME M IL ADD ESS CITY&STATE ZIP PHONE
VE
DIRECTIONS
TO JOB SITE �.� — IU 2 , D A)
LEGAL 1 (❑ SEE ATTACHED S EET)
DESCR. �L?A10A3 � W K�;�v,O I O Z lZ I Ucoe O
NAME MAIL ADDRESS d#rY S STATE LICENSE NO. PHON
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
1 Z b f�(l-b E — Ll y Z fmr►,t
Valuation of work: $ / /. PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: (c'
BEDROOMS {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 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.
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
1 which this permit is issued and that all work done will ROAD ACCESS
} be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY A ROVED FOR ISSUANCE
er —- - - Date.&
CASH
HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
PLOT PLAN
ADDRESS PERMIT NO. c
s o
0
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA \ Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS � m 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 P"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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
w
Q
1/We certify that the proposed construction will conform to the dimeruidns end uses shown above and that no changes will be made without
first obtaining approval.
NAME(e) OF OWNERS) O SITE 6 STRUCTURE(S) (PRINT) �'10 ATURE OF -L (a OR AU THORI O R P ESEN TA TIVE
DO NOT WR/TE BELOW TN/S LINE
APPROVED
DISTRICT AS NOTED DATE
•HCI-TON PRINTING
Richards, Steve 6 Mary #13555
876-2557, Bremerton 1/27/83
30-23-2, Tract 1 of Survey 6/10
NE end of Haven Lake, 2/10 mile down NE Tahuya-Black-
smith Road.
Mobile Home Contractor:
1982, 24'x44' None Listed
$19,536.00
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