HomeMy WebLinkAboutBLD18681 Mobile Home - BLD Permit / Conditions - 5/27/1986 TYPE MOBILE
'ermit No. 18681No. Floors 1 Ftg 1,28
leaner FREEMAN, Rona Tell?47O Date 5-
ddress W4360 Cloquallum Rd, Shelton;WT-- Zip
'ontractor
ddress Zip
egal ascription HOMESTEAD ACRES NO. 2, Block 2
)irection to project site 4-1/2 mi out Cloquallum Rd, new
driveway on left (red flagged) (1.2 mi from power line
crossing to driveway)
lumbing Mc anical Sewer Wood Stove
ireplace Deck age —7arport
asement Loft Other
iorelines: Plunbir)g:
Mechanic
ce ial Interior:
cnditions: FINAL:
Mobile Home:
,%Wke DetectOL
Remarks:
cotin
?tbacgk:
:)undation
ills:
raming: PERMIT
fireplace:
cod stove:
DATE +9---- - a - --
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 -1 J✓J J
426-5593 DATE ISSUED 7 ✓ ' ` ��PI
PERMITNO. /Y&
NAME MAILADDRESS CITY&STATE IP PHONE
OWNER P Lt/`lP a �► ��z t(A - 71-t S
TO JOB DIRECTIONS E d a (J "7 , b-if J9•Pc g' C P L f
- i � 201/ d Z f+-.��Q� •�� c:+•a, o e�� l t•-i a t.n �.1�v g
LEGAL /
DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF . p
BUILDING M `vuty act c
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE /
WORK �� -
BEDROOMS DECKS CARPORT NOTICE
c SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS Z. TOTAL SQ. FT. GARAGE CONDITIONING.
NO.OF STORIES i 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. I ZSy FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNER rn:? U' . --DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT S ,
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE ~�
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
kir BY - Q—) CASH CK MO TOTAL t1.`
PLOT PLAN
DDRESS j!fbL-14*/� `� ����� .//1_ PERMIT NO. f o
= o
n D
D OO
EGAL
ESCRIPTION 2 BILK �_ ADDITION u
res
ITE AREA2_(_0 )c 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
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. * +o �--� i,, I I oc
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
GHELT ON PRTNTIN�