HomeMy WebLinkAboutBLD7222 Mobile Home - BLD Permit / Conditions - 8/22/1980 Soltis, Robert A. #7222
8-22-80
From Belfair, take No. Shore Rd 2 mi. , right on Sand Hill
to 1st left (Bowden Court) , property on right
Lot 54, Beard's Cove - 3rd Addition
Mobile Home
$11,429.25
BUILDING PERMIT APPLICATION
•. •�� MASON COUNTY
o J P.O. Box 186 Shelton, Washington 98584
I�
426-5593
DATEISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS /� 4Wto')
TO JOB SITEIfj.n 'I'k, A/. g.. "
LEGAL (❑ SEE ATTACH D SHEE
DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR / Al
1 O MP
USE OF
BUILDING �'j� / 'er&S
Class of work: ❑ NEW ❑ AD151TION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Ale 4-1
Valuation of work: $// 40 0 �j' PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: ��--
BEDROOMS DECKS CARPORT L NOTICE
BATHROOMS__ TOTAL SQ. FT. GARAGE [J
ATTACHED I 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE L DETACHED L
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 Ll SHORELINES I
SEASONAL [] FLOODPLAIN I
Firm
E.D. NO. S.E.P.A. I ',
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I ce ify that I am exempt from the requirements of the FIRE MARSHAL
cc tract or registration law RCW 18.27, and am aware
the Mason County ordinance requirements for BUILDING DEPT.
hich this permit is issued and that all work done will ROAD ACCESS
be in conformance t rewlth. MOT PR VEHICLE MIT
AP ATION A C D BY PLANS CHECK BY VED F ISSUANCE
Owner y Date �� BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. f o
= o
n >
LEGAL L� 3 C► �lliv'��� Cf "•
DESCRIPTION LOT �5 / BLK ADDITION �:
SITE AREA ZQ/)/ 1 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"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'
7 y4`
i
!� it
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.
Jo'�-�r 'tip � .5
NAME(S) OF OWNER(S) OF SITE h 31'J4'UCTURE(S) (PRINT) IGNATU F OWNER(S) O AUTHORIZED REPRESENTATIVE
NOT WRIT I,BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
LPR:NT.IN'i