HomeMy WebLinkAboutBLD4529 Mobile Home - BLD Permit / Conditions - 4/19/1979 Rohde, B. K. #4529
4-19-79
J. 0. Echler D.L.O. 36-21-3
6 miles N. Shelton on Highway 3
Mobile Home
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&s�E ZIP PHONE
_?45�/ ,
DIRECTIONS
TO JOB SITE /�//LC `V ��L LTGSL/ f IV rClGyl(�/
LEGAL � (El SEE ATTACHED SHEET)
DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF 'L:5 _ _ r
BUILDING �-- L /j/` K_L� --j'
` 7'� /�4'/L/(�
Class of work: ❑ NEW ❑ D/DITI�ON ALTERATION ❑ REPAI El MOVE ❑ REMOVE
Describe work:
Valuation of work: $� PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
�— /
BEDROOMS DECKS CARPORT ❑ —' NOTICE
BATHROOMS___!e TOTAL SO. FT. GARAGE Ll
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES l BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT.�0Ci I FIREPLACE ❑ DETACHED ❑ �—
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 i
SEASONAL ❑ FLOODPLAIN I
Firm E.D. NO. S.E.P.A. F
By Special Approvals IN OUT
YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
1 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
be in confor there ith�/ MOTOR VEHICLE PERMIT
t �ipBC ��-.�f•�t APPLICATION ACCEPTED BY PLANS CHECK BY PROVED FOR ISSUANCE
Owner 4— Date
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. 'GASH
PLOT PLAN
i \
ADDRESS � � � `-' PERMIT NO. f o
LEGAL
DESCRIPTION LOT BILK 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"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'
Ll
L%
)
I/ certif he proposed construction will conform to the dimensions and uses shown above and that no changes will be mode without
first i rova1.
NAME(S) OF OWNERIs) OF SITE 6 STRUCTURE(SI (PRINT) IGNA TURE OF NER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING