HomeMy WebLinkAboutBLD20765 Mobile Home - BLD Permit / Conditions - 8/18/1987 Shorelines: A1,q Plumbing:
Setback: Mechanical :
Special Interior:
Conditions: FINAL: ,;�Ile �9
MobileHome:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 20765 No. Floors Sq Ftg 720
Owner REYNOLDS, John Tel 426-3800 Date 8-18-87
Address SE 150 Teagle Dr. Shelton Zip
Contractor None
Address Zip
Legal Description 2-20-4 Tr 1 of Sections 2.11 & 12
Direction to project Site Across Hwy from Airport
Grocery. North 101 Apts.
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1969 12x60 2 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED_ ' —
PERMIT NO
NAME , �AILADDRESS� CITY&STATE ZlPPHONE
OWNER IYec- S�>c6
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DIRECTIONS
TO JOB SITE ( `ft�U� ?�i1 Lw1 (� �� f V b 0,vu
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PARCEL LEGAL
NUMBER DESCR.
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK � �� ��' G)/—2
74�-
BEDROOMS DECKS CAR IF PORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 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 SO.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSAFFIDAVIT 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 DEPAR M NT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER h�'� D T ����� X BY DATE
t
FOR OFFICE USE ONLY
DEPAIJITMENT APPROVED DEPARTMENT APPROVED
YES NO YES NO BUILDING VALUATION
l
HEALTH - — PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT ' ' `..
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE `
OPLICATION ACCEPTED B APPR NCE PERMIT VALIDATION
B CASH CK MO TOTAL
PLOT PLAN
ADDRESS CJ 0 / � �1 � �-e f o PERMIT NO. 0 10 �
z
o
LEGAL
DESCRIPTION LOT BLK ADDITION
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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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174
-
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(SI OF OWNER(a) OF S1TE S STRUCTURE(S) (PRINT) GNATURE OFOWNER(S) OR AUTHORI-ZED REP ESENTA E
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE /���/� Z