HomeMy WebLinkAboutBLD0058 Final Mobile Home - BLD Permit / Conditions - 1/5/1989 1
Shorelines: AIA Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:® / 5' F9
Mobil Home:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 0058 No. Floors I Sq Ftg 580
Owner DARRELL L. QUALLS Tel 276-3134 Date 11-29-RR
Address P.O.Box 464 Belfair Zip 9852R
Contractor Same
Address Zip
Legal Description Beard's Cove Div 5 Lot74X 65
Direction to project site NE 1480 Larson Lake Lane
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATEISSUED �9 g
PERMIT Ng. 0 S
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER rj,g/yKEL e Le 0 Q)9L.46 ' /20
DIRECTIONS
TO JOB SITE A/t /4$ /qA;SOti /-/C Lyt! 1 /,3 L 1z;-0L1A 5Lzr•
>�ilcFt 'A40 lol330 .5 A 0 c 0 6S
LEGAL e e7 6 r of 0044'NA C•0VE' nfv. ivo, s .us ff Ero/t A�/J rti' vow Ue�c- g v�i"��+TS
DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR S�rF v Hti4 t 0 U
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR [MOVE REMOVE
WORK r
DESCRIBE
WORK :5-e,7- U p /74 .3 SIC NCNBII—
BEDROOMS a DECKS _ CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS j 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 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. � FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASO AL
O ERSAFFIDAVIT CONTRACTORS AFFIDAVIT
CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
EGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
, 1 X OWNQ *y �! ef DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT Y SPPROVE NO DEPARTMENT YESPPROVENO •
BUILDING VALUATION �U
C �. (G
HEALTH A PUBLIC WORKS FEE
PLANNING IVAFIRE BUILDING PERMIT rdo
D.O.T. BUILDING UA
SPECIAL CONDITIONS BUILDING GROUP �3 PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION .� r
BY �� CASH CK MO TOTAL a /�)
/'A< <=� ,t.c+ z ,3,3�' c�crc��`S" PLOT PLAN
ADDRESS �� 1 r/�l G(// �/7��, `'�'SjC PERMIT NO. �� o
r1,14 0,44` f'^= JAL/tjS %�/��t'��Ji� /i 4 h'/7 j G9� /tr/*✓0'C' 1 i
LEGAL �[y C. r O x, y/ allrlif� � R
_DESCRIPTION . `Sj LOT � 5 BLK ADDITION a W,
SITE AREA 2 0n Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
�.
INSTRUCTIONS TO APPLICANT
r
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- SL
TION THEREOF. r �.
V,
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
v,
1A-1�.
IE �
G
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.
n
NAME(SI OF OWNER(S) OF SITE 6 ! RUCTURE(S) (PRINT) IGNA TORE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE