HomeMy WebLinkAboutBLD16480 Mobile Home - BLD Permit / Conditions - 2/1/1985 GROSKOPF, Wilbur G. #16480
2-1-85
Tract 3, NE-1/4, SE-1/4 17-23-1
7925 Forest Ridge Dr. NE
Bremerton 98310 692-1211
2 miles North of Belfair on Old Belfair Hwy
Contractor
Poulsbo Mobile
Homes
Mobile Home 1985 14x66 Replacing older mobile
$17,094.00 2 bdrm.
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final: e 7 s-
Stop Work:
Mobile Home:
Smoke Detector:
Remarks;
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
L . 0MOS�foPr— 79Zj O?Asr )?/D G t PR . r iQt ill ArA7�/v 014 6��-,.
DIRECTIONS 98�/s
TO JOB SITE I L k S �U /f p t ,CQ41 /R few
LEGAL (❑ SEE/ATTAHED SHEET)
DESCR.
NAME 1AILADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR L /vJ0 /L E OMt�
v L t o 6 97-13s:S—
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: /9��r/
Valuation of work: $ / ��,/ / PLAN CHECK FEE PERMIT FEE�f/
/ j/
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT [l NOTICE
BATHROOMS _ ITOTAL SQ. FT. GARAGE [
ATTACHED i_ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT - OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE `. DETACHED U
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
rdinance requirements regulating the work for which
e permit is issued and all work done will be in
0nformance therewith. PERMANENT SHORELINES
SEASONALf FLOODPLAIN ! 1
Firm
E.D. NO. S.E.P.A. i
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
jOS XLICV N ACCEPTED BY PLANS CHECK BY RO FOR ISSU E
J,
Own" ate. o
17
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. C
PLOT PLAN
ADDRESS PERMIT NO. o 0
A D
a c
LEGAL a
m
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 Al"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'
II I�
W-7ZI
--
a
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
6HELTON PRINTING I