HomeMy WebLinkAboutBLD9906 Mobile Home - BLD Application - 6/8/1982 ' BUILDING PERMIT, APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
19
131Q q-ypQ 426-5593
DATE ISSUED
_ PERMIT NO. / a �✓
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
R. W. Henningsen P. 0. Box 205 Belfair, WA. 98528 2 -208
DIRECTIONS
TO JOB SITE N.E.380 Highway 300 Aprox.700' Westerly of Old Belfair Hiwv 8c 00 Junct .
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Tract 5 of NW 1 SE '- Sec 29 T 23 R e1 WWM
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING Residence
Class of work: CXNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Mobile Home Instalation
Zi
Valuation of work: $ o U PLAN CHECK FEE PERMIT FE€
2G � -3 s
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. 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 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 F On
OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT V 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. 6-
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
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Ow ne / r�G=.1/� ' ` -J Date . 6/7/82 7 BY
M.O. CASH
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.
I PLOT PLAN
f
_ADDRESS NE 380 Highway 300 PERMIT NO. f g
' = o
n >
LEGAL Tract 5 Sec.29 T23 R1 WWM
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS- Acreg 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 P"ID 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.
R. W. Henningsen PatL.Henningsen
NAME(S) OF OWNERS) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
�1 GHELTON PRINTING