HomeMy WebLinkAboutBLD4470 Mobile Home - BLD Permit / Conditions - 8/16/1979 McElhaney, Larry #4470
8-16-79
S� E2 A SA SWk Sec . 9 Twp . 23N Rg. 1W WM
St. Rt. 3 Box 4Q0 Belfair
Mobile Home Contractor
Bremerton Movers
$5, 900. 00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 45*—«P 7?
PERMIT NO. -1-51710 `
OWNER NAME MAIL ADDRESS CITY&STATE ZIP P NE p
DIRECTIONS Ga '� 14 M.\ e- a rO�r ���� ` � dr s mar�1 n5--�3p
TO JOB SITE r
LEGAL / (❑ SEE ATTACHED SHE
DESCR. ( = 1 1 �/ i �3
AlAAIL ADDRESS CITY&STATE LICENSE O. H NE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
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Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
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SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT [J NOTICE
BATHROOMS___ TOTAL SO. FT. GARAGE ❑
ATTACHED Cl SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT.`jZ0 FIREPLACE ❑ DETACHED CI
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 SHORELINES [
SEASONAL [] FLOODPLAIN f J
Firm E.D. NO. S.E.P.A. [1
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 conformance therewith. MOTOR VEHICLE PERMIT
Ama yoma, t4)1 tir) -7 EAPPL ATION ACCERTED BY PLANS CHECK BY PROVED FOR IS A C�Owner
V _
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O., CASH
A ,
PLOT PLAN
ADDRESS �(_y3 (�jY, ^� Q�t�, �\ ( PERMIT NO. 0 o
\
LEGAL �\tl L. I /L V ,l �jl.J�lH I S�- 1/41 se'�ei,R ' �WP -3! �'C' ` �• ( a
a
n
DESCRIPTION LOT BILK ADDITION u
SITE AREA brJ 1 ✓1 y 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 P"'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 1
INDICATE NORTH IN CIRCLE - -
%'- 1
` Y .
1
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.
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NAME(S) OF OWNE IRM-076 RU UREI ) (PRINT) , N TU F O NER R AU TN RIZE PRESENTATIVE
DO NOT WRIT FLOW THIS i4E
APPROVED
DISTRICT AS NOTED DATE
6HELTON PRINTING