HomeMy WebLinkAboutBLD20516 Mobile Home - BLD Permit / Conditions - 6/29/1987 Shorelines: Plumbing:
Setback: E Mechanical:
Special Interior:
Conditions: FINAL: C/ 2 8 M F7
Mobile Hcme:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Fr awning:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 20516 No. Floors Sq Ftg 550
Owner BROWN, Gary Tel Date—U--ZT--9T-
Address E 9090 Hwy 106 union Zip
Contractor Olympic Trailer Movers
Address Zip
Legal Description Tr 4 G.L.-3 5-2 -3 Tr 1 S/P 15
Direction to project site E on 106 2.1 miles E of Alder-
brook Inn on right side. Old Casa de Canal property
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1965 1Ox55 2 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED -20
P
ERMIT NO.'��'`� f�
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
Q Qow(V �qog� Hw �vb ui\\lotA Lk) (�
DIRECTIONS 1
TO JOB SITE - O O(o
PARCEL / LEGAL , L�
NUMBER �� �� �Q�'% DESCR. // 7`-f--
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR nQ�"\PkQ �RAI
USE OF
BUILDING O 6ALE `A(�p
CLASS OF NEW ADDITION [ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS L DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.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 SQ. FT. 5d;�_ 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 DEPARTMENT. c� APPROVAL FROM THE BUILDING DEPARTMENT.
DATE �-LC�- X BY DATE
FOR OFFICE USE ONLY
DEPAR MENT YEAPPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP k PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CH K BY APPROVED FOR ISSUANCE PERMIT VALIDATION _
BY � �� CASH CK MO TOTAL` �)
PLOT PLAN
ADDRESS 010QC) 1AV_)k< ���,Q� �7� PERMIT NO f v
LEGAL
DESCRIPTION LOT 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 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.
IINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
i C 1.) ;
b
1/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.
NAM CM OF OWNER(S OF SITE S STR C EM (PRINT) ICNATURE OF Q_ ER(S) OR AU MORI ZED REP ES ENTA TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE