HomeMy WebLinkAboutBLD21198 Mobile Home - BLD Permit / Conditions - 11/16/1987 Shorelines: A114 Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:c1-2
Mobile cme:
Smoke Detector:
Remarks:
Doting:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 21198 No. Floors Sq Ftg 1568
Owner BROUGHTON, William K Jr Te1275-6495 Datell-16-87
Address NE 2400 Old 1Belfair Hwy Belfair Zip
Contractor None
Address Zip
Legal Description Tr 8 SW,NW 16-23-1
Direction to project site
NE 2400 Uld Beitair Hwy
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1987 28x56 2 bdrm
I
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED 111116V4
PERMIT NO.
N ME MAILADDRE S CITY&STATE ZIP PHONE
OWNER ` H Ir
DIRECTIONS <
TO JOB SITE � 1�O O �L--/� �,� /}�` S2 111
PARCEL LE13AL
NUMBER 3 DESCR. r� U� Scv j
CONTRACTOR
NAME MAIL ADDRESS CITY d STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING -e_LAll19 T'
CLASS OF NEW / ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE WORK cl s 'x ;J _
7
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS Z 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. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
JREGI
RSAFFIDAVIT CONTRACTORS AFFIDAVIT
FY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
ATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
EMENTS 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
FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
NG AP,PPR,,OVVyAL FROOM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
ERA74' DATE ly1`7 �7 XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES IN
NO DEPARTMENT YESPPROVEN0 BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP V PRE-INSPECTION
JO (,l SHORELINE
WOODSTOVE
l.l.0 LUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPR UANC PERMIT VALIDATION
CASH CK MO TOTAL //fay aD
PLOT PLAN
ADDRESS PERMIT NO. i o
= s
n >
� 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
) �l
`r
I/We certify that the proposed construction will conform to the dlmensidhs and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF WITZ a fT RUCTUREIfI (PRINT) I N TUR F OWN 1 OR AU TM I D REP E3ENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE