HomeMy WebLinkAboutBLD15509 Mobile Home - BLD Permit / Conditions - 5/9/1984 SARVER, Michael L. #15509
5-9-84
Tract 7, NW, SE 21-23-1
P.O.Box 1390
Belfair, Wash. 98528 275-2944
(Directions Attached) Contrac for
Self
Mobile Home 14x 56 1979
$14,504.00
1 OZZY76
1
Shorelines :
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls :—
Fr am I ng:
Fireplace:
Wood Stove:
Plumbing:
Mechanical •
Roof :
Exterior:
Interior:
Final :
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
125:8M(T
DATE .q"qkly
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 6f1L
DATE ISSUED — 7�f
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 8 STATE _ ZIP PHONE
A,- rnyer
y
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
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DESCR. /Q -7 A & 5,F
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR 15 a w, c lA. 0i�
USE OF _0
BUILDING Res/Ala G�
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR EK MOVE ❑ REMOVE
Describe work: �
l!t e ! i D
Valuation of work: $ PLAN CHECK FEE PERMIT F s
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT L; NOTICE
BATHROOMS I TOTAL SO. FT. ft GARAGE
ATTACHED I_7 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES 1 BASEMENT Ll OR AIR CONDITIONING.
TOTAL SO. FTAft 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.
/he
State of Washington and I am aware of the FOR OFFICE USE ONLY
inance requirements regulating the work for which
permit is issued and all work done will be informance therewith. PERMANENT i- SHORELINES yY
SEASONALii FLOODPLAIN ;
Fir
E.D. NO. S.E.P.A. i_'
Special Approvals IN OUT YES APPROVED NO
Li 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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conforma a there h. MOTOR VEHICLE PERMIT
A LIGATION ACCE TED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner t y`r� Date y� D% B -71
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. f o
A D
D OO
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"=20'
�n c
l d
, C}
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 & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING