HomeMy WebLinkAboutBLD7516 Mobile Home - BLD Permit / Conditions - 9/30/1980 Soltis, Robert A. #7516
9-30-80
From No. Sh. Road, take right on Sand Hill, lst left on
Ward, 1st right on Bowden Ct. , u 2nd left - on left
Beard's Cove, Lot 3 53, Div. 3
Mobile Home
$11,429.25
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
<V�
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRE ZIP PHONE
OWNER _.. •., CI &S ATER k1A -399
DIRECTIONS
TO JOB SITE 0 x •// Ist 4,W on
LEGAL 1 .�� n` � � �� (❑ EEATTACHEDSHEET)
DESCR. /U\ 06
CONTRACTOR NAME MAIL AD DRES CITY&STATE LICENSE NO. PHONE
PS Ik 7
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: /
Valuation of work: $ PLAN CHECK FEE !_ PERMIT FEE 1-25
SPECIAL CONDITIONS:
AP LI TION ACCEPTE BY PLANS CHECK BY AP O D FOR ISS NCE Type of Occupancy Division
BY fonst. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor In RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ance requirements f SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued that all work done will
of
in onformance t erewi THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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
Own gr
Date. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO.
s o
LEGAL �7
DESCRIPTION LOT — 6L7C A DDDIT10N p�
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS / KY �<�, Soo 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 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.
ODINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
7 \
r
V
I
V
C'
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be without
first obtaining approval.
NAME(S) OF OWNER(5) OF SITE h ST RUCTUREl3) (PRINT) "'SIGN E F OWN R(5) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6NELTON PRINTIN"