HomeMy WebLinkAboutBLD0100 Final Mobile Home - BLD Permit / Conditions - 11/18/1983 BUILDING PERMIT PPL ICA TIO N
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED�� /
PERMIT NO. C�
OWNER NAME AIL DDR S 8 ST TE' ZIP PHONE
r e k
DIRECTIONS + ! y�r
TO JOB SITE 1 '2 ' �`a '� a ALE _ 1)40j i o Nye. N 51
LEGAL ��� `y i1 ' teat r r--r 0r-tkc N, l Z er— .1 4ac%,r-'9-er SEE ATTACHED SHEET)
DESCR. Ey f kZ h1. t2u®+'44.r" � �� �fi� 8='tst /P J 0 tt ► %���.s 1es 1
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF BUILDING ✓' D y jlftl
Class of work: -' NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ 0 PLAN CHECK FEE PERMI FEE �—
P- �G
SPECIAL CONDITIONS:
BEDROOMS {DECKS JIM CARPORT,' NOTICE
BATHROOMS (TOTAL SO. FT.- GARAGE ?'
ATTACHED-r SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT. fogOR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE DETACHED t
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 ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the F F I C E ,�J e S E ONLY
N eL Y
ordinance requirements regulating the work for which
FOR the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
BY Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
I rtify that I am exempt from the requirements of the FIRE MARSHAL
c ntract or registration law RCW 18.27, and am aware
BUILDING DEPT.
f the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conforma therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOFjISSUANCE
O ner ;? -- Date � z BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS 6" L �f l�' �/ PERMIT NO o 0
= o
� s
LEGAL a a
DESCRIPTION LOT BLK ADDITION
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 A-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'
I!VVe certJry thak the proposed construction will o the dimensions and uses shown above and that no changes will be made without
firdt ubtairtng approval
NAME(S) OF O Ek(SY OF SITE & STRUCTURE(S) (PRINT) IGNATURE OF OWNERS) R AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED -
DISTRICT AS NOTED DATE
SHELTON PRINTING
MILLER, Glenn & Sandi #0100
11-15-83
East 885 ft. of the Nz, 4,NE4, 20-23-1, lying Westerly of
of the Old Belfair Highway
12 mile North from Belfair on Old Belfair Highway -
NE 1151 Old Belfair Highway
Contractor
Mobile Home Self 275-5145
$17,390.00
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