HomeMy WebLinkAboutBLD11172 Mobile Home #504 - BLD Permit / Conditions - 8/7/1981 CATHERS, Elaine #11172
E. 140 Blevias Rd. No. , Shelton 08-07-81
Evergreen Trailor Park, Space 26
Mobile Home Contaactor - Self
$14,687.72
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED—
PERMIT NO. / /
7
OWNER NAME MAIL A DRESS CITY&STAT ZIP PHONE
C l S ��
DIRECTIONS
TO JOB SITE
LEGAL I (7 SE ATTACHED SHEET)
DESCR. ���' Ire �rA� l r �Gt r'� Z
CONTRACTOR
NAME MAIL ADDRESS /, ' / CITY&S TE LICENSE NO. PHONE
l
USE OF
BUILDING1 kNEW
r (Class of work: F] ADDITION ❑ ALTERATION ❑ REPAIR XMOVE ❑ REMOVE
Describe work:
1 O
Valuation of work: $ � �� �� PLAN CHECK FEE PERMIT FEEU,
SPECIAL CONDITIONS:
BEDROOMS DECKS _— CARPORT ( l NOTICE
BATHROOMS TOTAL SQ. FT.____ GARAGE I
ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT 1 1 OR AIR CONDITIONING
TOTAL SQ. FT. FIREPLACE I 1 DETACHED
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 FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANEN SHORELINE
SEASONAL f_, FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT. p
OWNERS AFFIDAVIT HEALTH DEPT.
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
b in conforman therewith. MOTOR VEHICLE PERMIT
LICA ON A PTED Y PLANS CHECK BY APP OVED FOR ISSUANCE
Own r IaiCC `� ate. BY
�f�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
r
PLOT PLAN
ADDRESS �V ,Pr'
MIT NO. o
n 1
a o
LEGAL
DESCRIPTION LOT BILK 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 ARID 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I
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.
NAME(S) OF OWNER(S) OF SITE 6 3TRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PRINTIN3