HomeMy WebLinkAboutBLD0139 Mobile Home Replacement - BLD Permit / Conditions - 4/3/1984 BUTCHER, Robert 0. #0139
4-3-84
E-1/2, NE-1/4, W-1/2, NW-1/4 20&21-23-1
Tract 27
P. 0. Box 1343
Belfair, Wash 98528 275-3957
NE 101 Riverside Place, Belfair Contractor
None listed
Mobile Home Replacement
$17,760.00 24x40
. . .
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior :
Interior :
Final:
Stop Work:
Remarks:
I
i
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �
PERMIT NO. 0 3
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
vTc , B, e - 7
DIRECTIONS
TO JOB SITE
LEGAL WO WAtj5R- 10AN XORd i T BYFAt y (❑ SEE ATTACHED SHEET)
DESCR. L C_
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING pW �� 1a C e i�e i77—
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Z4-MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE �S
7 766, 00
SPECIAL CONDITIONS:
BEDROOMS_ I DECKS _ CARPORT [; NOTICE
BATHROOMS TOTAL SQ. FT. _ GARAGE [ '
ATTACHED i 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [; OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE I-i IDETACHED Ll
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 I am aware of the FOR OFFICE USE ONLY
ord Hance requirements regulating the work for which
th permit is issued and all work done will be in
c formance therewith. PERMANENT SHORELINES
SEASONAL I FLOODPLAIN I 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. O
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 in conformanccea therewith.� `, MOTOR VEHICLE PERMIT
Owner C/ lG� Date Yj6L- /L APPLICATION ACCEPTED BY PLANS_C44ECK BY APPROVED FOR ISSUANCE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. f o
z °
n D
2 O
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 A"°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 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=2.0'
�-
/ O
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I
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 OWNERW OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PWNTINu
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