HomeMy WebLinkAboutBLD11431 Mobile Home - BLD Permit / Conditions - 9/16/1981 `Adams, Chas. C. #11431
9/16/81
Lot 257, Division #1, Timberlakes
Enter Timberlakes, Turn Right, first intersection
go to end of Small Lake, turn left after passing
through intersection, on left, lot will be the
only cleared lot on left, past third house
Mobile Homes
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BUILDING PERMIt APPLICATION
i MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED- _ Q w. 17 tJ
PERMIT NO. //' I
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
ti e s
DIRECTIONS
TO JOB SITE �� 1 y j S Ok -,tF
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF /
BUILDING
Class of work: ❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
/11 U
Valuation of work: $ 16; / s� �(j PLAN CHECK FEE PERMIT FEE��.�S_
SPECIAL CONDITIONS: (d�7cC
BEDROOMS 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 SQ. FT. FIREPLACE ElDETACHED ❑
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
Owner U�f/ l! � ' """ Date_ 9'A 0 / APPLICATION ACCEPTED.BY PLANS CHECK BY APPROVED FOR ISSUANCE
P N HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
> PLOT PLA14
ADDRESS
PERMIT NO. o c
= s
LEGAL a °o
DESCRIPTION 1►/ LOT S- BLK ADDITION aa
a
SITE AREA re. Sr00 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 CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION P"'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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
1/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
NAME(a) OF OWNERS) OF SITE 6 STRUCTURE(a) (PRINT) SIGN TUR OF OWNERS) OR AUTHORI ED R P ESENT TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
•H[LTON PRINTING