HomeMy WebLinkAboutBLD6431 Final Mobile Home - BLD Permit / Conditions - 6/5/1980 Beals, Glenn #6431
• 5-19-80
Old Belfair Hwy, 2nd house on right
-2$-23-1 - W of N 1/2 of NE 1/4
.219
Mobile Home
13 764.00
it BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
✓19,r-L{
PERMIT NO. 1
NAME MAI DDRESS 9U e— CITY&STATE �jP / PHONE
OWNER fil I 2A �S 3 Q a�e_�;ettJ �h�r�-,zrto �'4 �0 5I "7 7�--�.Z7
DIRECTIONS
TO JOB SITE 10fq G Id /3e- -PA i, I- N I h ,q _ a h d house_ 9
LEGAL C 1-1 9 (❑ SEE ATTACHED SHEET)
DESCR. oJ� _ . ,:RYTkj/i. p3 _ ' �.c� of N. '1
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING fz-4 1
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
—6A 'y
Valuation of work: $ / PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT L1 NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED LI SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO, OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
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 1 1 SHORELINES LI
SEASONAL [I FLOODPLAIN [I
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 BUILDING DEPT.
of th Mason County ordinance requirements for
is this permit is issued and that all work done will ROAD ACCESS
conforms c therewith. MO R VEHICLE PER IT
A ATION ACC BY PLANS CHECK BY AP ED FOR IS ANCE
0 e
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION (CK. M.O. CASH
i ' . k
• A PLOT PLAN
ADDRESS PERMIT NO.
f
a
LEGAL
DESCRIPTION LOT BLK ADDITION
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.
INDICATE NORTH IN LE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
h ,
,S.
� . � 0
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 6 STRUCTURE(S) (PRINT) J \GN T F OWNERS R A T R NTATIVE
DO NOT WRITE BELOW /S LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING