HomeMy WebLinkAboutBLD16151 Cancelled Mobile Home - BLD Permit / Conditions - 1/9/1991 SIMMONS, Darrell R. #16151
9-21-84
Beards Cove, Div. 5, Lot 4
NE 3170 Hwy 300 #44
Belfair, Wash 98528 275-3676
Hwy 300 to SandhillRd. to Larson Lake Blvd. to Scooner
Loop to Harpoon Drive on corner.
Contractor
Bremerton Mobile
Home Movers
Mobile Home 3 bdrm. 1980 14x66
$17,094.00
1
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final:
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
PERisi IT
DA
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
/uL� 7O 30d PERMIT NO. „� f/
OWNER NAME MAIL ADDRESS CITY 8 STATE ) ZIP PHONE
S 6
DIRECTIONS Qo xwe'
TO JOB SITE )YWY 00 0 /LC ROAD 710 ,eSoiv.(/4Xz b"4v6TO SC0mV 1_OO To
LEGAL J' �c _ / (❑ SEE ATTACHED SHEET)
DESCR. � 1J Q CJ � ✓, r� /�j 0,� j/
NAME AIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
�mf AJ
USE OF
BUILDING �� f
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR I1 MOVE ❑ REMOVE
Describe work:
v Vo Fgpwi &�qTzo /o7- AT Pllie,( ,c 401£
i of e A4 TO RW
Valuation of work: , /,. PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT[CARPORT [j NOTICE
BATHROOMS--,?,-- TOTAL SQ. FT. GARAGE LJ
ATTACHED I_; ` SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT E; OR AIR CONDITIONING.
TOTAL SQ. FT FIREPLACE X DETACHED 1
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 FOR A PERIOD OF 180 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 SHORELINES -76^
SEASONAL I ' FLOODPLAIN L'
Firm E.D. NO. S.E.P.A. [ I
B 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 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
ICA N ACCEPTED BY PLANS CHECK BY APPR VE F ISSUANCE
Owner __ Date . rtp-1 L
B/Y
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS AQ0 P `d- h A P P06V i)P I L)e PERMIT NO. 0 o
la D
LEGAL
D O
O
DESCRIPTION LOT �C,/ /)j0 BLK ADDITION "
u
SITE AREA_ O /00 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 14 �' 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.) CA
r� FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- W
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION A"D 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-
IP-
TION THEREOF.
...5 h
(�) INDICATE NORTH IN CIRCLE GRAPH SQUARES AR&,.b' X 5' OR 1"=20'
WN
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 9
v A S(-)," _M C>j_,r a.,.� _ep
JJ£13(1Mtf SI-t",vto>03 &-iLA- e'( l? Llt2 ��1 0�
NAME(S) OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3