HomeMy WebLinkAboutBLD11036 Final Mobile Home - BLD Permit / Conditions - 8/7/1981 EISENHARDT, Ronald E. and #11036
Pamella M. 07-20-81
P. 0. Box 855,Belfair
NW1/4 NE1/4 SE1/4 NW1/4, 21-23-1
Turn left into Weyerhauser Sand Yard, take first road to
left, go over R/R tracks, immediately over tracks take
right, go shor 1 block, road on left, down dirt road
about 400', CAUTION entreme loose sand: : :
Mobile Home Contractor - Self
$34,188.00 /Z32,1 zG/ F6s--6
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BUILDING PERMIT APPLICATION
MASON COUNTY 21
P.O. Box 186 Shelton, Washington 98584
426-5593 C/
DATE ISSUED �0 - a
PERMIT NO. .11d&gn
NAME MAIL ADDRES CITY 8 STATE ZIP PHONE
OWNER r ecak
9 7
DIRECTIONS
TO JOB SIT
LEGAL (❑ SEE ATTACHED SHEET)
DESCR 7� E !/ l _ /
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: >� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ,
Valuation of work: $3 C C e-0 PLAN CHECK FEE PERMIT FEE /61 7, 7S
SPECIAL CONDITIONS: O O
BEDROOMS__ {DECKS CARPORT NOTICE
BATHROOMS (TOTAL SO. Flo-- — GARAGE L
ATTACHED L SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT Ll OR AIR CONDITIONING.
TOTAL SO. FT. ' FIREPLACE ❑ DETACHED L
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 FORA PERIOD OF 180 DAYS AT ANYTIME 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 I
SEASONAL ❑ FLOODPLAIN L
Firm E.D. NO. S.E.P.A. L1
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
b n coMEA
ewit MOTOR VEHICLE PERMIT
` �� / ATION ACC TED Y PLANS CHECK BY APPROVE R ISSUAN Date . 7
LAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION k,, CK. M.O. CASH
r PLOT PLAN `" ��z V �CZJ-6
ADDRESS � ���1 C I PERMIT NO. 0 o
s
A D
a D O
O
LEGAL
DESCRIPTION LOT BLK ADDITION` u
SITE AREA /� Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS vC) 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.
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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. f' /
NAME(3) OF O ER(3) OF 317E 6 31RU11URE(3) (PRINT) G ATU E OF O NER(3) OR AUTHORIZED RE SEN TA TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRTNTIN3