HomeMy WebLinkAboutBLD19789 Mobile Home - BLD Permit / Conditions - 1/9/1991 TYPE MOBILE HOME
Permit No. 19789 No. Floors 1 Sq Ftg 1456
Owner BERG, Carl A. Tel Date 1-23-87
Address NE 70 Peg Leg Ct. Bel ai�'r — Zip
Contractor Norm Bunko
Address Zip
legal Description Beards Cove Div. 4 Lot 29
Direction to project site
Smmt- nddrPti-; ns ahovP
PlLrnbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1987 28x52 3 bdrm.
------ — ---------
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
MobileHorne:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 f
JJ 426-5593 DATE ISSUED / �G-
/p?,3,�Q 51 40QQC� � PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER ,� 1 /I( .0 .cf.
DIRECTIONS 4
TO JOB SITE L /
J� J :yQ u
LEGAL
ME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR �D
USE OF
BUILDING p
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE t ') x
WORK /V1 d 13, � J
BEDROOMS DECKS CARPORT 410 NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS _ TOTALSQ.FT. V6 GARAGE &0 CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. / v0 FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT ✓ SHORELINE
SEASONAL
OJFHAT
FFIDAVIT CONTRACTORS AFFIDAVIT
I I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
RE LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
RES FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
INNCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT
BUILDING VALUATION
HEALTH e PUBLIC WORKS FEE
PLANNING �� FIRE BUILDING PERMIT
ley, 715
D.O.T. BUILDING V,17 PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP X'_ PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE �Q
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANSCHE BY APPROVEDFO IS NCE rPERMITVALIDATIONBY ASH CK MO TOTAL �� �+�-
PLOT PLAN
ADDRESS PERMIT NO. f
0
= o
n >
a o
LEGAL
DESCRIPTION LOT BLK ADDITION u
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 AND 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
t )
�71
1 w
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1/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) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE