HomeMy WebLinkAboutBLD18579 Mobile Home - BLD Permit / Conditions - 5/2/1986 TypE MOBILE HOME
Permit No. 18579 No. Floors 1 Sq Ftg 1568
Owner PARKER, Edward Thl275-6687 Date 5-2-86
Address P. 0. Box 582 Allyn Zip
Contractor None
Address Zip
Legal Description Tr. 3 13-21-2
Direction to project site Off Hwy 3 turn on Grapeview
Loop Rd. 1st left 1.2 miles
Plumbing Mechanical Sever Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1986 28x56 3 bdrm.
shorelines: Plumbing:
setback: Mechanic
)jDecia1 Interior:
bnditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
botinqq
setback:
bundation
Talls:
'raming:
'ireplace:
Tood Stove: rj ,
DATE By
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY BSTATE ZIP PHONE
'62Gv �8"2 .L/CIv t// 0511 Qfl52 q ,7 5DIRECTIONS
TO JOB SITE G 3 ` /U
(fu L s
LEGAL f /_ r- ,
DESCR. t 7
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF �/j� 7�/r�
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 TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 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
SEASONAL
JREQUI
SAFFIDAVIT CONTRACTORS AFFIDAVIT
THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
TION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
ENTS 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
RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
G APPROVAL FROM THE BUILDING A TMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNE - ATE 2— X BY DATE
OR OFFICE USE ONLY
DEPARTMENT YES
PPROVE NO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY AP ROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
-alto �. CASH CK MO D
n a
PLOT PLAN
ADDRESS S7 PERMIT NO.
= s
LEGAL �-Sur�G L. 1/ J
DESCRIPTION, L T / BLK ADDITION
/ 1
SITE AREA I1' /Z 6-1& Ft. AREA OF SITE OCCUPIED BY BUILDINGS:1'f 1 3a�--�Y 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'
1
'J L1
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. L "
x ems; --
NAME(al OF OWNER(S) OF SITE i STRUCTURE(S) (PRINT) SIGNATURE OF WNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE