HomeMy WebLinkAboutBLD26096 Mobile Home - BLD Permit / Conditions - 7/5/1990 c)q
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile cme:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE mo n I I F HnmF
Permit No. 260% No. Floors 1 Sq Ftg 1368
Owner HAIIG N_ OWFN M. Tel 898_4030 Date 1-5-90
Address F 150 Main _ Itninn Zip
Contractor
Address Zip
Legal Description UnJn City Grays Harbor UCRR bl 11 lot
Direction to project site 9-10
At Ilninn Qn to Main un hill snuth to 3rd St right side
um ing Mechanica ewer Wood Stove
Fireplace Deck G7a age arport
Basement Loft Other xx
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
X 186 98584 P.O. BOX SHELTON, WASHINGTON � �9O
427-9670 DATE ISSUED
PERMIT N0.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER a ,�. U i - 9' ,03
DIRECTIONS
TO JOB SITE 9
LIIV;-DV: �ie 7"0 U /L
PARCEL L Z -,S p-C 'LEGAL
NUMBER DESCR. ,BLS; /I
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING �y c _ FU/
CLASS OF WORK NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK REMo✓E O L a i ,=
BEDROOMS 92 DECKS YORN CARPORT NOTICE
TOTAL SO.FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. TOTAL SQ.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED,
PERMANENT FIREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
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.
X OWN ATE X BY DATE
FtWOFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH L-1 PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP Ji ti. PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE `
APPLICATION ACCEPTED BY I PLANS CHECK BY �VED/b-R ISSUANCE PERMIT VALIDATION
�' ( CASH CK MO TOTAL 9 t 00
r LYS/
j
v
.r
PLOT PLAN
ADDRESS /— I1 S —)� �� l� /Iy `� �l tr/y PERMIT NO. 4 .
0
LEGAL 0
z
0
DESCRIPTION3?2J a LOT BLK ADDITION t °.
SITE AREA /YYM Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS IS6 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. SHriW 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.
6N
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I
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V�
,
f- 3 z F yo
4-- .
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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(a) OF SITE a STRUCTURE(S) (PRINT) GN TURE OF OWNER(S) OK AUTHORI D REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE