HomeMy WebLinkAboutBLD20167 Final Mobile Home Space 50 - BLD Permit / Conditions - 4/28/1987 Shorelines: �/�_ Plumbing:
Setback: Mechanic
Special Interior:
Conditions: FINAL:�J
Molt,
Smoke Detector:
_ Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
i
Permit No. 20167 No• Floors 1 SI Ft9 960
Owner George Kelsey Tel 426-9484 Date 04-27-87
Address E 1700 Shelton Sprines Rd Shelton ZiP 98584
Contractor Sun Mobile Homes
Address Zip
Legal Descrip—Si-on Hidden Haven Mobile Home�Tark
Direction to project Site Shelton Spring Rd HXy arrp
from Mirkeyfs
Plumbing Mechanical Plechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE[
PERMIT NO.
NAME MAILADDRESS CITY SSTATE ZIP PHONE
OWNER e,,e_oR LS i7vv syj,eLToiy S 3LieLfax L!1 6"
DIRECTIONS -/
TO JOB SITE /d0f/� Q�ff"7Dd
PARCEL LEGAL
NUMBER DESCR. /o7a- 'y 1500, '5 S
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR 54 &Z bzb-c " bvh to
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
WORK DESCRIBE
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORI ES _ BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED— ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE MIA
SEASONAL
OWN SAFFIDAVIT CONTRACTORS AFFIDAVIT
I C IFY THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
RE TRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
R UIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
I CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
TAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER/•Ka'�.p�c �� „ DATE �/°�2�0 ( X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION —
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING G FIRE BUILDING PERMIT 7 a5
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE /, 6'Q
STATE SURCHARGE
APPLICATION ACCEPTED BY PLAN§CC EC� APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL � J� J'6f
BY CASH CK MO
PLOT PLAN
ADDRESS PERMIT NO. 10
s
� °o
a
n
LEGAL
DESCRIPTION LOT BLK ADDITION a
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 AND 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'
74
t 2 v S
TT
I/We certify that the proposed construction will conform to the dimensidms and uses shown above and that no changes will be made without
first obtaining approval.
NAME(a) OF OWNER(S) OF SITE k STRUCTURFM (PRINT) SIGNATURK OF OWNERS) OR AUTHORIZED R P ESENTATIV
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED