HomeMy WebLinkAboutBLD11726 Final Mobile Home - BLD Permit / Conditions - 12/21/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 p
DATE ISSUED
PERMIT NO.
OWNER NAMEt �i�� 7— MAIL ADDR CITY BSTATy ZIP. PHONE
D� /rcur/mac . /--1 MAIeLz. `/:) PHONE
DIRECTIONS �-� t("
TO JOB SITE .-� /C f:.`�5-E' l�l` "- t i;` > Ji!•.k - >C -C tl S� e - - c
LEGAL �lu E-ci_. %/L'E'�cl� fZ J4c-C_ .1 -LCr{ . C�/-T:C1 ,,_ J/r, 1 /5 •-�=5� EA •HEY= EE ��•�.�
DESCR. L• .F r:' l� tE ' )P" .
CONTRACTOR
NAM� 0-
MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
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USE OF it
BUILDING IC-C :�/ c'��-1L-4
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: -
d�<�� / /,4. �� . IL
�L
Valuation of work: $ PLAN CHECK FEE PERMIT FE
,� S-
SPECIAL CONDITIONS: - 3 / -
4
BEDROOMS (DECKS CARPORT ;: NOTICE
BATHROOMS TOTAL SO. FT._ _ GARAGE
ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I OR AIR CONDITIONING.
TOTAL SQ. FTZRK-7 FIREPLACE I 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 FORA 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 V SHORELINES I '. k
SEASONALII FLOODPLAINr
Firm E.D. NO. S.E.P.A. t:
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
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEP / /" 9
which this permit is issued and that all work done will ROAD ESS
be in conformance, rewill h. / MOTOR VEHICLE PERMIT
-{c .. . :-fir.. /. �` •• / A (CATION CCEPT£D BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner__/`� _ (. .{)ate .L /k
PLVN CHECK VALIDATI CK. M.O. CASH VPERMIT VALIDATION CK M.O. CASH
PLOT PLAN
ADDRESS f�C' � (C L� " � PERMITNO.
LEGAL
DESCRIPTION LOT BLK 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,ANDSETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION A"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'
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- -- - - ._
I/we certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be mode without
first obtaining approval.
NAMEISI OF OWNER(S) OF SITE a STRUCTURE(S) (PRINT) IGNATURE OF OWNERISI OR AUTHORI ED RIEPPESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED �/
DISTRICT AS NOTED ��pZ DATE
iNCLTON PRNTIN6
Johnson, Jack & Kathy #11726
. (27575400) 11/17/81
Sam Theler's Home & Garden Tracts 35, 36, 36A
On Roessel Road, approx. 200 feet past clearing on right,
Mobile Home Contractor:
None
$28,416.00
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