HomeMy WebLinkAboutBLD6652 Mobile Home - BLD Permit / Conditions - 6/16/1980 Main, John R. #6652
6-16-80
2 3/4 mi. past Belfair old Hwy right hand side of road
NE NW 16-23-1
(Variance - no more than 30" highs
Mobile Home
$17,760.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426 5593 ��/�,
DATE ISSUED
PERMIT NO. ,
NER �IAM MAIL ADDRESS r CITY&
STATE,
P h Qs ZIP �7 J HONE
)DIRECTIONS
TO JOB SITE ,- 04-1 ! O O O
l0000ltEGAL /� 11 (❑ SEE ACH D SHEET)
DESCR. 7/y .I i J t{�� f/ �W h �► 3 IPC►► c
ME MAIL ADDRESS CITY&STA E LICENSE NO. PHONE
NTRACTOR n / ` r a // G /
aa-
USE OF L c'
UILDING
Class of work: 95,NEW ❑ A DITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: /94h� 6 Vxyo /9 v
Valuation of work: $ PLAN CHECK FEE PERMIT FEE yam
SPECIAL CONDITIONS:
�a
BEDROOMS DECKS CARPORT [I NOTICE
BATHROOMS TOTAL SO. FT. GARAGE Li
ATTACHED i SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT i OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE i ; DETACHED ❑
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 I SHORELINES
SEASONAL [1 FLOODPLAIN I
Firm E.D. NO. S.E.P.A. I i
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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 onformance therewith. M T VE MIT
// f1 A P ATION AC D BY PLANS CHECK BY APPROVED FOR ISSUANCE
caner , Date . Y V - BY
i
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATI N CK. M.O. CASH
l
PLOT PLAN
ADDRESS PERMIT NO.
Z f o
— a o
a o
a
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft.
INSTRUCTIONS TO APPLICANT
e
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.) J
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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
'L!V
f
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be m without
first obtaining approval.
NAMEW OF OWNERW OF SITE & STRUCTURE(SI (PRINT) IGNAT F OWNER(SI R AUTHORIZED REPRESENTATIVE
DON RITE BELOW IS INE
APPROVED
DISTRICT AS NOTED DATE
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