HomeMy WebLinkAboutBLD16221 Final Mobile Home for Storage - BLD Permit / Conditions - 10/10/1984 SAXTON, Norman
#16221
Colony Surf Div. 3, Block 1, Lot 10 10-5-84
P. 0. Box 569
Hoodsport, Wash 98548 877-9433
Contractor
Self
Mobile Home for Storage 1954 8x40
$1600.00
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BUILDING PERMIT APPLICATION • -
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 r
DATE ISSUED --
PERMIT NO.
AME IL ADD ESS CITY 8 STATE IP / !p- PHONE
OWNER G/f'/�'� �� 6 �e3 -�8 _74 7
DIRECTIONS %zo
TO JOB SITE
LEGAL. / (❑ SEE ATTACHED SHEET)
DESCR �"� 1y3/
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
f�G t'
USE OF
BUILDING _
Class of work: )<NEW' 'ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe rk:
T_ oU
Valuation of work: $ PLAN CHECK FEE PERMIT FEE I-Q�
SP CIAL CONDITIONS:
o ! c ! e.6 /rL GL.Sc- 4 •G r
.>zA-
BEDROOMS I DECKS _ CARPORT [, NOT I C E
BATHROOMS___ TOTAL SO. FT. GARAGE Fl
ATTACHED I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE C DETACHED L
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
jFirm
rtify that I am a currently registered Contractor In WORK IS COMMENCED.
State of Washington and I am aware of the FOR OFFICE USE ONLY
nance requirements regulating the work for which
permit is issued and all work done will be in
formance therewith. PERMANENT LI SHORELINE
SEASONAL 1 FLOODPLAIN
E.D. NO. S.E.P.A.
Special Approvals IN OUT YES APPROVED NO
Date ZONING
PLANNING DEPT.
HEALTH DEP
OWNERS AFFIDAVIT
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 ;-
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
e in conf here ith. MOTOR VEHICLE PERMIT
LI ION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
wner .�ance
�.-" u ea� �~ BJ�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. o
= o
n >
a o
a
LEGAL ^
DESCRIPTION LOT BLK ADDITION u
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 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
lk R
�9
I/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.
NAMES) OF OWNERS) OF SITE R STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED °1 I,�c/� ✓I) � DATE
DISTRICT AS NOTED
/
6HELTON PRINTING