HomeMy WebLinkAboutBLD18655 Mobile Home - BLD Permit / Conditions - 5/21/1986 1
TYPE MOBILE. '
Ftg 792 I
Permit No. _18655 ,c No. _Fl.ors 476-8622Dtte 5� 1
(Owner BARBER, Mike- _ Zip 5-337
;AddressE.O. Box 32 Gorst WA P
Contractor
'Address -Zip
Legal Description I 1/4 -
Direction to project site err AmmnruFD
I
'.Plumbing Mechanical _i Sewer Snbod.Stove
,Fireplace Deck Garage `Z`a port
Basement" Loft Other.
BUILDING PERMIT APPLICATION f
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 02
DATE ISSUED
PERMIT NO. U to &
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
1A *A1�A 2 ,D 3 60 eYj
DIRECTIONS 004V 6o,tS7 Toc.A eco CROSS iyiA-5oi✓ CLp, T,-kely )ele'vr 4> to k e r
TO JOB SITE ICV_ T cN A.-mr A ' - LoC &,eo -s Am;
LEGAL / (❑ SEE ATTACHED SHEET) 'LAC
DESCR. �� 8a� N. / rA9 Al �.
CONTRACTOR -NA E MAIL ADDRESS CI &STATE LICENSE NO. PHONE
USE OF
BUILDING I �S1 ) elv-e
Class of work: PrNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: /
Ala a. z s
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
'3`I 6c). o o
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. .�- FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and t 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 tIll 0,
SEASONAL Ll FLOODPLAIN L1
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. A
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 conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Dates G' �� . BY,�
l� J
PLAN CHECK VALIDATION CK. M.O. CASH V U PERMIT VALIDATION CK. M.O. ASH
CHRISTMASTOWN PRINTING J
PLOT PLAN
ADDRESS / /�c7 /3 /� �Q �Q f Af, L✓W'RMIT NO. o
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA e) 1,16 4---�q,F--t— 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 AO"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.
0 Yj
F INDICATE NORTH IN CIRCLE 1�,{,a !a` GRAPH S40ARES ARE 5' X 5' OR V-20'
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I/We certify that the proposed construction will conform to the dimansidns and was shown above and that no changes will be made without
first obtaining approval.
"MI(S) OF OWN QR(il Or i17Q \ a RUC TURCti) IPRIN TI UR OF OWN R(!1 UTHORI D REP E6 EN TA TIVE
DO NOT WRITE SE,l TN/S LINE
APPROVED
4STRIC7 AS NOTED DATE
�HRISTMASTOWN PRINTING I