HomeMy WebLinkAboutBLD82-12223 MOBILE - BLD Permit / Conditions - 8/13/1982 Schramm, Trucking #1222
426-8887 8/13/ 2
N 1/2, SE 1/4, 4-20-4
Mason County Landfill
Mobile Home Cont actor:
24'x30' None Listed
$13,320.00
200y L4C 0 5-bo
f
r � x
i
t
v �
a
lidaJ f V O N D •• -co
u ro ro ° G•� o 0 o x �;
aJ •ca p u ca O r-4 cn •ri p H •H •• 3 N
ra ca -o •ra a .G CO .. �4
�4o � v G. cnr-1
r CO vLZ � w Co Cl
O ° ocnn ) o � O X .0
4w +r, �
BUILDING PERMIT APPLICATION
chi ra r IT)
MASON COUN Y
P.O. Box 186 Shelton, Washin ton 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NA ME MAIL ADDRESS CITY&ST TE F ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL `� V �, /'� (❑ SEEATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CI &STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING � �L= r,•_, �,
Class of work: Q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: `
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS__— DECKS _ _ CARPORT ❑ NOTICE
BATHROOMS ITOTAL SQ. FT. GARAGE [7
ATTACHED f.] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT CO AMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME 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 OFFICE USE ONLY
ordinance requirements regulating the work for which
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. 17
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DE PT.
OWNERS AFFIDAVIT CEEALTH DEPT.
PUBLIU WORK
I certify that I am exempt from the requirements of the FIRE MARS
contract or registration law RCW 18.27, and am aware U—IL DI A
of the Mason County ordinance requirements for of
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
Owner( ;?&'�� Date .� A LICATIOAC TED BY PLANS CHECK BY BPPROVED FOR ISSUANCE
CK. M.O. CASH P .RMIT VALIDATION OK. M.O. CASH
PLOT PLAN
i
ADDRESS PERMIT NO. _ o
z °
n s
a c
LEGAL
DESCRIPTION LOT BLK ADDITION "
u
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 P"'D 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 RAPH SQUARES ARE 5' X 5' OR 1"=20'
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.
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE