HomeMy WebLinkAboutBLD2098 Mobile Home - BLD Permit / Conditions - 9/30/1987 la3av - �0 - �'33a�
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
PERMIT—
Fireplace: NULL VOID BY DATEWood Stove:
/-�=- -BY
TYPE MOBILE HOME
Permit No. 20998 No. Floors Sq Ftg 1232
Owner LOFTHUS, Donald Tel Date 9-30-87
Address P 0 Box 1236 Belfair Zip
Contractor Factory Home Spec.
Address Seattle zip
Legal Description Por E-1/2.NE 20-23-1 (Tr B S/P #732)
Direction to project site 1 mile No. of Belfair on Union
River. NE 71 RivArgjL pl rt-
un ing Mechanical ewer Stove
Fireplace Deck Garage Carport
Basement Loft Other
1987 28x44 3 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED - 7
PERMIT NO:' eZ
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
S ee i 13 n k -2 3 44 41_f�mieA
DIRECTIONS
TO JOB SITE /3 - (, A4 i,
A/ic. 71 R V
PARCEL / /, � �� LEGAL /� e r
NUMBER 1 DESCR. �yjj- .1t /,3Z ���
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
?efolp Z3
USE OF TeA•MWA
BUILDING 7CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS �_ DECKS CARPORT NU NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE D CONDITIONING.
NO.OF STORI ES L BASEMENT_&e7 ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
OMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT./ FIREPLACE a& DETACHED A CBANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE i1/f
SEASONAL
OWNERS AFFIDAWT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
ADEP
ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
NE DATE X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED
TMENT YES No DEPARTMENT YES NO BUILDING VALUATION
HEALTH ^� -�� PUBLICWORKS FEE
PLANNING FIRE BUILDING PERMIT 9,a�
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY P W, C PERMIT VALIDATION
CASH CK MO TOTAL
PLOT PLAN
ADDRESS NIL ZZ IJ A('f— PERMIT NO s a
= o
� n
fl s o
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. _
<' `x iF0 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- T
TION THEREOF.
i
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
.10
ok
�y
i
I/We ie'ify that t natructin ill conform to the dimensions end uses shown above and that no changes will be made without
first obta'ning appr al. �o
�r
J�� i i srC L -j _n l
NAMEIS) OF OWNER(S) OF SITE 6 STRUCTUREM (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED ESEN TA TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE 3�-" < jS