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HomeMy WebLinkAboutBLD2021 Mobile Home - BLD Permit / Conditions - 6/1/1979 Davies, Ivan #2021 6-1-79 29-23-1 Tr. C NE 1/4 SE 1/4 Highway 3 to Old Belfair Highway right on Roy Boad for 400 Mobile Home 12 32 q - `41 - g0030 i 1 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 'J LA h� 7Q DATEISSUED PERMIT NO. © � / OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS TO JOB SITE I✓Lv ll'i�IIZ, � i LEGAL �{ (❑ SEE ATTACHED SHEET) DESCR. 5je�L- /�—! Ttv� 3 kl c® ' —� V NAME MAIL ADDRESS CITY&STATE .LICENSE N PHONE CONTRACTOR ` o` L / 7 e— USE OF lf , BUILDING —0-m lL d �_L/tiC NeA) 6WIL)(212 exc' l e Class of work: ❑AEW ❑ ADDITION1 ❑ ALTERATION ❑ REPAIR JKMOVE ❑ REMOVE Describe work: 4,9XX1/I)6 T/J l ql X 70 / 7e ,I-1 o6k,—r A'o272e- . / r'14 a 9 If , �oui Valuation of work: $ PLAN CHECK FEE PERMIT FEE aO, &---a SPECIAL CONDITIONS: BEDROOMS DECKS _ CARPORT Ll NOTICE BATHROOMS_ TOTAL SO, FT. GARAGE I I ATTACHED I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ElOR AIR CONDITIONING. TOTAL SO. FT. FIREPLACE ❑ DETACHED [1 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>ie SHORELINES ❑ SEASONAL ❑, FLOODPLAIN ❑ Firm E.D. NO. S.E.P.A. ❑ 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 per it is issued and that all work done will ROAD ACCESS b n confor a ce therewith. MOTOR VEHICLE PERMIT Own r� Date / A. PLIICATION ACCEPTED BY PLANS CHECK B BBPPROVED FOR ISSUANCE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS a • PLOT PLAN ADDRESS PERMIT NO. f o , I z � LEGAL SEC �I _rW Z_3Ili yC IL& 1-1, S4A.) eb ' $ 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 I PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION ARID 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. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' 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. NJ N NAME(S) OF OWNER(S) OF SITE Q STRUCTURE(S) (PRINT) AIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE G.EITON PnINTINa