HomeMy WebLinkAboutBLD7776 Mobile Home - BLD Permit / Conditions - 12/14/1978r
Brown, George R. #7776
12-14-78
_ G. L. 6 35-22-3
12 mile from Belfair on North Shore Road
Mobile Home
I
�2-�2 s'�7�
��OCr i�2/��,
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �s�—��y ✓7�
PERMIT NO. / Z /
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
*r A7S dI
DIRECTIONS
TO JOB SITE I Z �L #e L fz Q
LEGAL 77 - e p� (❑ EE ATTACHED SHEET)
DESCR. Gyc%, 7 ZQT eo ��� J.S —n"f I)S 22 N Xpf/11)E; 3 W
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING ic
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ 1� • PLAN CHECK FEE PERMIT FEE aD
SPECIAL CONDITIONS: '
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
NO. OF STORIES BASEMENT ElATTACHED CI SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED El
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 [J
SEASONAL CI FLOODPLAIN l 1
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. 7
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
BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY AP VIED FO SUANCE
Owner '� Date. 7� B
PLAN HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
L4 A) PLOT PLAN --
ADDRESS ; z _ (�• �L,. iy/ �S F �JC, PERMIT NO.
LEGAL DESCRIPTION G.yyLOT 5e-(. :j5 .22A,/,?,j44LK ADDITION
SITE AREA 3VZC.) Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS r4?2Y4 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 AP"D 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'
IT
I ,
� Y I
U
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) -SIG UR OF OWN ER(Sl OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
STRICT AS NOTED DATE
,ELT,ON PRINTIN'�