HomeMy WebLinkAboutBLD9396 Mobile Home - BLD Permit / Conditions - 10/10/1979 Morse, John N. #9396
10--10-79
Grays Harbor & Union City Railroad Tracts Lots 29, 30,
31 & 32 Blk 8
Towards Union turn on 5th Street,
turn left 2nd street off 5th mobile home on left down
100 ,
Mobile Home
r
.,� BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 r!J-jU- 7cf
426-5593
DATE ISSUED /
M Q �2U a0_t_ kP T NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP _ UN
DIRECTIONS D 3a.. ebL 0C_ KZJ-QI
TO JOB
LEGAL s L�� D7` �- (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR MOVE ❑ REMOVE
Describe work:
S ei- C) ! r
Valuation of work: $�/, 00 o-r) PLAN CHECK FEE PERMIT FEE s�
SPECIAL CONDITIONS:
BEDROOMS.__Q— DECKS CARPORT L NOTICE
BATHROOMS II TOTAL SO. FT. GARAGE 11
ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L7 OR AIR CONDITIONING.
TOTAL SO. FT.,da FIREPLACE ❑ DETACHED fJ
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 FOR 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 I
SEASONAL ❑ FLOODPLAIN [
Firm E.D. NO. S.E.P.A. I
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. d, " j
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
be in conformance therewith. MOTOR VEHICLE PERMIT
Owner Date .�
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED F.OR ISSUANCE
7
0
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
r
PLOT PLAN
r '
ADDRESS ( ( _ �l(J/� � �[J ( 1` /'. Iq�x_, PERMIT NO. F o
A >
a o
LEGAL
DESCRIPTION LOT J�'J )�11 .� I `j 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 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.
0 INDICATE NORTH IN CIRCLE GRAPH 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) IGN URE OF OWNERS) OR AUTHORIZED REP NTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3