HomeMy WebLinkAboutBLD10455 Mobile Home - BLD Permit / Conditions - 4/24/1981 NEILL, Craig #10455
04-24-81
Off North Shore Road
Lot 65, Div. 5, Beards Cove
Mobile Home
$6,375
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i
BUILDING PERMIT APPLICATION
` MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426.5593 / �L1--W)
DATE ISSUED /
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS /�
TO JOB SITE Or 'fio-.V Sgftir 640
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. A V SZ-4 ,D S C41.e
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING Lrs`� �"a G
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR irMOVE ❑ REMOVE
Describe work:
Sf UIle
Valuation of work: $ PLAN CHECK FEE n PERMIT FE�/,
SPECIAL CONDITIONS: /C�L
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOM TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES��--++ BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT.3/ FIREPLACE ❑ DETACHED ❑
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 LI
SEASONAL Ll FLOODPLAIN LI
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLA
OWNERS AFFIDAVIT HEALTH DEPT.
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 of r ance erewith. MOTOR VEHICLE PERMIT
ZI ' A ATION ACCEPTED BY PLANS CHECK BY APPROV
ED FO FOISSUANCE
Own r �'L '�� �1/ ate. //
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS 26 T ��iy 5 15-4 t OS CO v C PERMIT NO. 0 o
A >
a o
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA �SV Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 556 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 A14D 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 R 1"=20'
2
2
Q
N
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 h STRUCTURE(S) (PRINT) IGNA E OF O N (S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PnINTIN3