HomeMy WebLinkAboutBLD10536 Mobile Home - BLD Permit / Conditions - 5/7/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME ` MAIL ADDRESS CITY&STATE ZIP PHONE
' 4�' J1l.' v 5
DIRECTIONS FiCsa•l��tT7�' /1ac,G
TO JOB SITE •! O�q/ Q ,y/
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LEGAL �v e7A �OQ�7� /7,' GJE$T �2O7j �T pf �v� �E y ( SEE ATTACHED SHEET)
DESCR. �j 5W NI_45?"G'2 7�✓1�.Zc -
NAME MAIL ADD ESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class A work: X NEW ❑ ADDITION ElALTERATION ClREPAIR MOVE El REMOVE
Describe work:
•
Valuation of work: $ cb " PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: Z O
K r
or loo,
BEDROOMS I DECKS CARPORT [] NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
SEPARATE RE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [] ATTACHED Ll OR AIR CONDITION 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 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
SEASONALI FLOODPLAIN u
nzot
Firm
E.D. NO. S.E.P.A. L]
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
� i�nlor,mance,therewith. MOTOR VEHICLE PERMIT
ATIONAC PTEDBY PLANS CHECK BY APPROVED FOR ISSUANCE
OwneDate5:/-7&L B
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O. CASH
y PLOT PLAN
)DRESS PERMIT NO. ,
GAL G✓ i GJ��2Q7�7�� SG✓y . —/ a3/�,� we�'/�?
'SCRIPTION LOT BLK ADDITION N
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"ID 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 TH REOF.
I
DI TE NORTH IN CIRCLE, GRAPH SQUARES ARE 5' X 5' OR 1"=20' l�
S . as _W 35 yd W 6V 4S 711 75 50 tF_ 90 95- e'✓ •cS //o Ar
5
7s
3�
3s
t/o
Hf
5-V
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Gs
�e Fl—
so
190 i
9
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. )T / i
�f c
r
r1JEIS OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) _3IGNATURE OF OWNERM OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
TRICT AS NOTED ,
i
�CLT ON PRIN TINO
MACOMBER, David M. #10536
05-07-81
From Belfair approx. 1 mile down Old Belfair Hwy -
right on Newkirk Rd. , then right on dirt drive just
before Old Red Log
S1/2NE1/4SW1/4, Sec. 21, Twp 23 N, Rge 1 W
Contractor
Bremerton Mobile
Mobiel Home Movers
$14,000.00