HomeMy WebLinkAboutBLD6189 Mobile Home - BLD Permit / Conditions - 4/16/1980 Soltis, Robert A. #6189
4-16-80
Beard's Cove Lot 3 Blk 3
Mobile Home
f���� �/�3/�o
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. U/Ol0 7
OWNER ME MAIL ADDRESS CITY&STATE ZIP PHONE
s / a DI -
RECTIONS
TO DI JOB SITE �' � y`
LEGAL. ��3 / / (❑ SEE ATTACHED SHEET)
DESCR d k 3 /'�X'��2Q' S V
NAME IL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
/,ne /
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ 9, S�Q / PLAN CHECK FEE PERMIT FEE /�Or
SPECIAL CONDITIONS: 'X
BEDROOMS_ _ DECKS CARPORT IA NOTICE
BATHROOMS_ TOTAL SO. FT. GARAGE 11
ATTACHED C 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_ BASEMENT i! OR AIR CONDITIONING.
TOTAL SQ. FT..M FIREPLACE (, DETACHED CI
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 O N Y
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT L I SHORELINES I 1
SEASONAL f I FLOODPLAIN I 1
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 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 ' sued and that all work done will ROAD ACCESS
be in fo an they with. MOTOR VEHICLE PERMIT
,�/ A LIGATION ACCEPTED BY PLANS CHECK BY APPROVE FOR ISSUANCE
Owne r ___ Date/ -
11 1��OAIY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. 4 0
= v
LEGAL
DESCRIPTION LOT BILK ADDITION
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'
Let
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.
galbe,g� k
NAM (S) OF OWNER(S)AOF SITE 6 STRUCTURE(S) (PRINT) I NA RE O WNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRTNTIN: