HomeMy WebLinkAboutBLD15351 Mobile Home - BLD Permit / Conditions - 4/4/1984 STEINMETZER, Donald J. #15351
4-4-84
Tract 12 N-1/2, NW, NE Ex. R/W 20-23-1
NE 1580 Old Belfair Hwy
Belfair, Wash 98528 275-5531
Get on Old Belfair Hwy and go approx. 1.8 miles.
Located on right side a little past Union River Bridg e
Contractor
Self
Mobile Home
)232,DIZo! 120
$21,312.00 1982 24x4 2 bdrms.
011VL C111105
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior :
Interior :
Final:
Stop Work:
Remarks:
NULL & VOID , i EXPJR4'TION
DATE / '9'71 BY 4a _,.�...._..�.
i
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 ,J
DATE ISSUED 5'
PERMIT NO.
OWNER NAM MAIL ADDRESS CITY 8 STATE ZIP PHONE
0 5 D c a w e( a r WA
DIRECTIONS From IBcI rIr -geEon old i5e1 i'v H-k./�/ a-A gv �proX imafr-Iq 1.8 miles-
TO JOB SITE jjC &, h ifS'
LEGAL1r (❑ SEE ATTACHED SHEET)
DESCR. Z q W D_ 3
CONTRACTOR
NAM[ MAIL AD RESS CITY 8 STATE LICENSE NO. PHONE
(^�
USE OF `J Q /y� /
BUILDING HQm� —7/ /Q�CjI /F )
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work In c Q D11 -C Mobile
of
Valuation of work: $ p.� PLAN CHECK FEE PERMIT FEE o*5
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SQ. FT. GARAGE -
ATTACHED i SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT a OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED C;
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 FORA PERIOD OF 180 DAYS AT ANYTIME 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
thF permit is issued and all work done will be in
c nformance therewith. PERMANENT SHORELINES
SEASONAL i I FLOODPLAIN I i
Firm E.D. NO. S.E.P.A.
By Special Approvals IN OUT YES APPROVED NO
Li o. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. Oil
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 'n conformance therewith. MOTOR VEHICLE PERMIT
AP LICATI N ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Ownef ate. BY
tr I q I - - I
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS 15f90old & alr 1&4 PERMIT NO. F
T : o
I1 D
2 O
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Scl.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 Ak'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.
(�f INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I
sep ti -
7-7 10
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) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHELT ON PWN T:N i