HomeMy WebLinkAboutBLD85-16437 MOBILE - BLD Permit / Conditions - 1/15/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washingtc n 98584
426-5593
DATE ISSUED
PERMIT NO. T 7
OWNER NAME MAIL ADDRESS CITY&STA c ZIP PHONE
39.11yd6
DIRECTIONS
TO JOB SITEI CW/ WCLE
(O SEE ATTACHE SHEET)
c•�
NAME MAIL ADDRESS CITY ST E LICENSE NO. PHONE
CONTRACTOR 4 n
USE OF
BUILDING learn 47/.-
Class of work: ❑ NE ADDITION ❑ ALTERA N ❑ REPAIR ❑,M VE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE P RMIT FEE
06 as-
SPECIAL CONDITIONS.
BEDROOMS 1 DECKS CARPORT ❑ NOTICE
BATHROOMS__ TOTAL SQ. FT. GARAGE ❑
SEPARATE PER ITS ARE REQUIRED FOR PLUM ING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I ATTACHED OR AIR CONDITI Nll G
TOTAL SO. FT. FIREPLACE ❑ DETACHED
THIS PERMIT BE MES NULL AND VOID IF WORK R CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT CO ENCED WITHIN 180 DAYS,OR IF ONSTRUCTION OR WORK IS
SUSPENDED OR BANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMM CED.
the State of Washington and I the
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 Iq
conformance therewith. PERMANENT SHORELINES y1
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEP .
OWNERS AFFIDAVIT HEALTH DEPT. 3 -p$.L
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
PR,in conformance therewith. MOTOR VEHICLEJ PERMIT
/ O� APPLICATION ACC TED BY PLANS CHECK BY APPROVED FOR ISSUANCE
caner Date . 4 C�2Z
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O. CASH
i
PLOT PLAN
ADDRESS PERMIT NO, f o
= v
n s
a o
0
a
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 SCA OF NOT LESS THAN 1"=2 ' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HA A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN HE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW B II'L DING,SITE,AND SETBACK DIMEW
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST F OR ELEVATION, STREET LEVA-
TION A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WAT , SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE F EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE RAPH SQUARES ARE 5' 5' OR 1"=20'
I IT
Ly-
I ttT
r
r
I/We certify that the proposed construction will conform to the dimensions and uses showr ibove and that no changes will b made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF WNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
6HELTON PRINTING
k
COLEMAN, Donna C. �� -�� ' #16437
1-15-85 "�
Lot 1 of Short Plat #1307 8-20-4
W 3961 Dayton Airport Rd.�
Shelton 98584 426-9372
j Across from Latvian.,;Center on Dayton Airport Rd.
Contractor
!Sun Mobile
Mobile Home 1969 12x54 2 bdrm.
i
00 (.can
$3,240.00
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