HomeMy WebLinkAboutBLD0121 Final Mobile Home - BLD Permit / Conditions - 6/27/1989 Shorelines: PlLubing:
Setback: Mechanica
Special Interior:
Conditions: FINAL:
Nbbile�cme:
Smoke Detector:
Remarks:
Doting:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Sq Ft 924
Permit No. 0121 No. Floors
Tel 275_ 4686 Date 6-6-89
owner LAP IN" Anthony A Zip
Address NE 22581 H,wt 3 Belfair
Contractor None Zip
Address
Legal Description Beard' s Cove Div 5 Lot 69
Direction to project site NE 1521 Larson Lk Rd-
Direction
ing c anica ewer Wo Stove
Fireplace Deck Garage Carport
Basement Loft Other
1985 1466 3 bdrm
. ;r
vk��j BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED—L/�
PERMIT NO. C-2 1 2 Z
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER /�• /lU S _ l i�-3 4RIp ja
DIRECTIONS Q ff8
TO JOB SITEPARCEL
NUMBER �� a� 9 DESCL Q- ����I�✓. ��r <p
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS_ TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORI ES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. FI REPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
!
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CER Y THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI RATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ EMENTS 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
IN NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OB INING APPROVAL FROM THE BUILDING DE RTMENT. y APPROVAL FROM THE BUILDING DEPARTMENT.
Z4WNE DATE % y� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
SPPROVENo DEPARTMENT YES No
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING elCl( PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
fit-n WAG SHORELINE
ivA J kt WOODSTOVE
PLUMBING
00 MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY P NS C B APPROVED FOR IS ANCE PERMIT VALIDATION
_ / / TOTAL 6717,
BYANt L CASH CK MO
PLOT PLAN
ADDRESS PERMIT NO. i o
= s
w >
s o
0
LEGAL
DESCRIPTION LOT BLK 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 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�
i
d
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.
&7-h1e Y A P/NS
F W R R A TM RI REP 3 NTATIVE
NAME(SI OF OWNER(S) OF SITE & STRUCTURE(!) (PRINT) IGNATURE O O NE ISI U O Z D E E
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE