HomeMy WebLinkAboutBLD11667 Mobile Home - BLD Permit / Conditions - 10/30/1981 Woodhead, Dan #11667
10-30-81
Beard's Cove Div. 5 Lot 26
Take 2nd right off county road into Beard's Cove
2nd right off that road onto Mason Blvd. Lot is on
corner
Mobile Home
$18,130.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. /(off
OWNER NAME MAIL ADDRESS CITY 3 STATE ZIP PHONE
1 r
DIRECTIONS
TO JOB SITE aft a T {hG
LEGAL ++ 7� (� (❑ SEE ATTACHED SHEET)
DESCR. °�lp V�V. �1R"Is
CONTRACTOR NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR X MOVE ❑ REMOVE
Describe work:
F
Valuation of work: �- PLAN CHECK FEE PERMIT F
4 7 S
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT Cl NOTICE
BATHROOMS TOTAL SO. FT.-qb6 GARAGE LI
ATTACHED L� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
S NO. OF STORIE BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ IDETACHED ❑
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 ll SHORELINES [I
SEASONAL [-] FLOODPLAIN 11
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 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
j� LIGATION CE TED BY PLANS CHECK BY APPRQVA&FOR ISSUANCE
Owner l a,;Ow UAI-gU-Ij Date.10150181 Y
PLAN CHECK VALIDATION CK. M.O. CASH WERMIT VALIDATION CK. M.O. CASH
i
PLOT PLAN
_ADDRESS � �� 4 ��l-I 1 yy� PERMIT NO 4
Sd�F� �fl�.•>� a o
LEGAL
DESCRIPTION��V' LOT �y BLK ADDITION
u
SITE AREA jam, C�_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'"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-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
5rt � x7 1 S 2111 (t
I
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.
_"by( 4Y n YY \\�11t� O'c"I'l
/
NAME(S) OF OWNERS) O SITE S STRUCTURE(S) (PRINT) NATURE O OW R(S) O AU RIZED REP ESENTA TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6MC LTON PWN7IN3