HomeMy WebLinkAboutBLD2337 Mobile Home - BLD Application - 8/8/1979 • BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 IF-
DATE ISSUED
Z/ 0-0-0` r PERMIT NO. 1&3
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
Johnson H. W. p 0 Box 878, Belfair 98528
DIRECTIONS
TO JOB SITE 30-23-1 S 1/2 S 1/2 Ne 1/4 Nw 1/4 Sandhill Road left at Johnson Sign.
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Same
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR Bayview Mobile Home Sales
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Mobile Home 24'x56' 1979
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
28,500.00 $20.00
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. F07 GARAGE ❑
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. 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. PERMANENTS 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 permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT S(�
& C ;� �iy� ��> Q Oft.-. .AP LICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
OwYner Date. tl ! (G & n ,W/ -)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH`"
l
PLOT PLAN
a 4'
a'
ADDRESS PERMIT NO. $
n s
3 0- I S' V2 s 4/- tX Y,1 A1W %
LEGAL e
DESCRIPTION LOT BLK ADDITION "
(� 1 N
SITE AREA 6 a Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS t-344 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 AKID 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'
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.N1
D-R LIIJ N
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.
i;��Vl.laze,
NAME(S) OF OWNER(S) OF SITE ! STRUCTURE(S) (PRINT) S I G N ALTURE 0&2MB"L O A THORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6N ELTON PRINTING
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