HomeMy WebLinkAboutBLD15046 Final Mobile Home - BLD Permit / Conditions - 1/19/1984 JENNINGS, Virgil #15046
12-27-83
Beards Cove, Division 6, Lot 36
NE 981 Larson Lake Road, Belfair
Contractor
Self 275-2349
Mobile Home
$1040.00
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final: QK/ -/ 9-Fs
Stop Work:
Mobile Home:
Smoke Detector :
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426 5593 � ��
DATE ISSUED �
PERMIT NO. I SO
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
E/�N 0 . Z
DIRECTIONS
TO JOB SITE E- L T
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. $ON -A - 1
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR XMOVE ❑ REMOVE
Describe work:
r k-
1g53
a08
Valuation of work: $ /0 anPLAN CHECK FEE PERMIT FEE
i
� S
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT f i NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE I_]
ATTACHED L_) SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE I 1 DETACHED L
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 ANYTIME 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 i
SEASONAL I FLOODPLAIN i 1
Firm
E.D. NO. S.E.P.A. i i
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
1�r
ify that I am exempt from the requirements of the FIRE MARSHAL
act or registration law RCW 18.27, and am aware BUILDING DEPT.
e Mason County ordinance requirements for
h this permit is issued and that all work done will ROAD ACCESS
conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY ROVED FOR ISSUANCE
Date.
7
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS N C LA jRra&2 (.YC RD rF�l2, PERMIT NO. / JG7 }�J f o
D O
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 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'
+3�.c,✓,-cam (�:�.Q i1.�a`�.�
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A aj
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.
NAME(S) OF OWNER(S) OF SITE d STRUCTURE(S) (PRINT) tIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
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APPROVED 1 �/ DATE
DISTRICT AS NOTED ; �>
6HELTON PWNTINu