HomeMy WebLinkAboutBLD13841 Final Mobile Home - BLD Permit / Conditions - 8/19/1983 I
W!:ite, Robert E. #13841
838=3969, Federal Way 6/3/83
14-20-2, Tract 4 of NE 1/4
Hartstene Island, right at stop sign at end of bridge,
go to stop on Hartstene North South Road, right to
1st driveway
Mobile Home Contractor:
28'x66' , 1983 Owner
$32,560.00
***Mobile will not be set up for possibly a Year or
So. FooEingg to be put in goon.
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6UILDING PtRMIT APPLICATION
1� MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 — ?3
DATEISSUED
PERMIT NO. 13 A
OWNER
NAME MAIL ADDRESS t CITV 8 STATE ZIP PHONE
Ll�
DIRECTIONS _ /40-ro,1'6. 1" ancj
TO JOB SITE n S e Y r JHPi Ilto 4 Sf t,va
LEGAL (❑ SEE ATTACHED HEET)
DESCR. Qc-�- Y
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR Q
w yl
USE OF
BUILDING RLc e-Y1
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
I
Describe work:
S
I9 .3
Valuation of work: $ O PLAN CHECK FEE PERMIT rrFs O
SPECIAL CONDITIONS:
BEDROOMS (DECKS CARPORT NOTICE
BATHROOMS_— TOTAL S. FT GARAGE Ll
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ ❑DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IFCONSTRUCTION OR WORK IS
I WORK IS ORABANDONED FORAPERIODOF180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in
the State of Washington and aware of the FOR OFFICE US ONLY
� ordinance requirements
the regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES
SEASONALX 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. :7�-& ✓N
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 rmit is issued and that all work done will ROAD ACCESS
be in CO ormance therewit MOTOR VEHICLE PERMIT
/F- A PLICATION=A//CC�E/PIED BY PLANS CHECK BV APPjROVE FOR ISSUANCE
' Owne Date = - a. V /o>-`
PLAN ECK VALIDATION CK. M.O. CASH PE MIT VALIDATION CK. f M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. i o
P
0
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA Q.(1-I-e% 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•'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTR CAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJORPOR-
TION THEREOF.
OINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X ' OR 1"=20'
i
� O
IIWe certify that the proposed construction will Conform to the dlmensidrn end uses shown above and that no changes will be m Elewithout
first obtaining approval.
AUTHORIZED REPRESENTATIVE
IONAT RE OF OWNERISI OR U
N AME(al 01 OWNER(S) OF SITE • STRUC TUREIa) (PRINT) U
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
eNELTON PRINTING