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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