HomeMy WebLinkAboutBLD9077 Final Mobile Home - BLD Permit / Conditions - 12/18/1980 Walthall, Eugene L. #9077
11-18-80
Beard's Cove - Lot 56
Mobile Home (Variance for blocks)
$26,640.00
Ay
` 4 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. O�
OWNER NAME MAIL ADDRESS CITY&STATE ZIP l rHONIr
zi
DIRECTIONS b �► f�
TO JOB SITE �e .— L. -/
LEGAL ri}abf��C C [�f=H��� CC l%t SGC' -,,I- /7y' /^G c t"G�.r (�SEE ATTACHED SHEET)
DESCR. e{ z,,i 3- ^
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW O ADDI ION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Q r e e =9��
0
Valuation of work: $ PLAN CHECK FEE PERMIT FEE 7�
SPE5^ CONDITIONS:
BEDROOMS {DECKS CARPORT ❑ NOTICE
i I
BATHROOMS_i_ TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIESBASEMENT ❑ OR AIR CONDITIONING,
TOTAL SQ. FT. 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 I I SHORELINES I 1
SEASONAL ❑ FLOODPLAIN LJ
Firm
E.D. NO. S.E.P.A. L;
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
/be
tify that I am exempt from the requirements of the FIRE MARSHAL
ract or registration law RCW 18.27, and am aware BUILDING DEPT.
he Mason County ordinance requirements for
h this permit is issued and that all work done will ROAD ACCESS
I
n conformance therewith. M T R VEHIC PERMIT
rPCAT710A PTED BY PLANS CHECK BY VED FO I CE
PLAN CHECK VALIDATION CK,. M.O. CASH PERMIT VALIDATIO , CK. I M.O. CASH
' PLOT PLAN
ADDRESS • P_ �„ Y �Ir� ERMIT NO. f `o
�-
= o
n �s
LEGAL j
DESCRIPTION LOT e -',L BLK ADDITION R 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.) o
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF r
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"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL r 1
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
1
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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A To LIN z E' / % r r RaP. A/ F
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1/We certify that the proposed construction will conform to the dimensions and ules shown above and that no changes will be made without
first obtaining approval. /0 ?rr PROP 4/Alt 7-0
����oS�'.D ?JRA/AJ FIELD.
NAM S) OF OWNER(S) OF lITE A STRUCTURE(S) (PRINT) SIGNATURE OF O ,N'ERI )/OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE E HIS L
APPROV D "� DATE �a
DISTRICT AS N0
SHELTON PRINTING