HomeMy WebLinkAboutBLD12285 Mobile Home - BLD Permit / Conditions - 4/21/1982 BUILDING PERMIT APPLICATION �f `
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 r�a
DATE ISSUED Q/
PERMIT NO. / JJ
MAIL ADDRESS CITY A STATE ZIP PHONE
jJOB
NAME ` p a 5 G a '�- `�S,�l-}f� / 9 - e
, C / g� ✓`' ,�� ��
/Z (L SEE ATTACHED SHEET)
,I y SW 9 �/ PHONE
NAME MAIL ADDRESS
CITY 6 STATE LICENSE NO.
R ` e He/y e-
Class of work: J*' W ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT F / gas
1 S l o. o � �EE i FJ
SPECIAL CONDITIONS:
BEDROOMS (DECKS__ -. CARPORT L NOTICE
BATHROOMS_-_- TOTAL SQ. FT. GARAGE [:SEPARA:TEERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIE��S,��q_q//�� BASEMENT L ATTACHED L DITIONING.
TOTAL SO, FT._/�Jil_- FIREPLACE L DETACHED II
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
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am aware of the FO OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in SHORELINES
conformance therewith. PERMANENT
SEASONAL [-, FLOODPLAIN L
Firm E.D. NO. S.E.P.A. L
Special Approvals IN OUT YES APPROVED NO
By
ZONING
Lic. No.—
Date
PLANNING DEPT. p
EALTH DEPT. -„�I-S d`
OWNERS AFFIDAVIT PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MAR L
contract or registration law RCW 18.27, and am aware gUl DING 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
xr LICATI N C PIED BY PLANS CHECK BY APPROVED R IS NCE
Owner X-`� Date Al- h4 - b2
P CHECK VALIDATION CK, M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. 4
i o
0
LEGAL BLK ADDITION
DESCRIPTION LOT
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 PAID 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.
OINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
!y
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.
N AME(ll OF OWN ER 5; OF aITE a fTRUC TUWEIaI IPRINTI IDNATURE OF OWNERI31 OR AUTHORIZED R P ES EN TATIVE
DO NOT WRITE FLOW TN/S LINE
APPROVE DATE
DISTRICT AS NOTED
...ITON PNINTINO
Friesner, Elmer L. #12285
426-7107 4/21/82
$il 'A/#, dE 1/4, SW 1/4, 29-20-2, Plat C
Arcadia Road to Lynch Road 8 first drive on right.
Mobile Home it a4,3'S Contractor:
1082 WOO' Self
$18,130.00