HomeMy WebLinkAboutBLD13788 Final Mobile Home - BLD Permit / Conditions - 4/20/1983 t.>
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Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
plumbing:
Mechanical:
Roof*.
Exterior:
InteriZkRll��
Final:
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
. BUILDING PERMIT APPLICATION
AL
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 3 - 3 1-S 3
DATE ISSUED
PERMIT NO. A Yo?
OWNER ' NAME A MAIL DRESS CITY&STATE ZIP - PHONE
DIRECTIONS cep �u—j— u�Y 3 TOP-4 ( (Zt1�oNv��w / v =1I�N� V/��ci Pa TL4'R
TO JOB SITE aC� �, / -- �, P
LEGAL (❑ S E ATTACHED SHEET)
DESCR. S Y.t S W y W Y Y S a -a I - Q se-
NAME MAMADDRESS CITY&STATE LICENSFAO. PHONE
CONTRACTOR LIT
L4 11,C PAO 46 Al r- O '
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR XMOVE ❑ REMOVE
Describe work:
S� 6 m % w
Valuation of work: $ PLAN CHECK FEE PERMIT FE
�3/ �'0. Do / /
SPECIAL CONDITIONS:
Ale /
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS__ TOTAL SO. F GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES / BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT/jo� 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
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
PLICATION2ACEPTED BY PLANS CHECK BY I APPROVED FOR ISSUANCE
Owner Date 313/' -&3 V 111� Y
P CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION M.O. CASH
PLOT PLAN
ADDRESS JE4,Qj-3/ `j=fi/,*&e/ e/iP 4U RC L�RAp_e kJf,Q PERMITNO. o
= s
s o
0
LEGAL A
DESCRIPTION LOT BILK ADDITION
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 CONTQURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AMD 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'
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1/We certify that the proposed construction wilt conform to the dimensioru and uses shown above and that no changes will be made without
first obtaining approval.
NAMES) OF OWNER(S) OF SITE S STRUCTUREIS) (PRINT) SIGNATURE OF OWNER(a) OR AUTHORIZED R P ESENTA TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GNELTON PRINTING