HomeMy WebLinkAboutBLD21289 Mobile Home - BLD Permit / Conditions - 12/7/1987 Shorelines: Plumbing'
Setback: Mechanical:
Special Interior: —
Conditions: FINAL: , i- /9 8 e
Mobile Hcme:
Smoke Detector:
Remarks: n,y
ooting
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE
MOBILE HOME .
Permit No. 21289 No. Floors Sq Ftg 55iL
Owner DOW, Kay Tel 871-2001 Date 12-7-87
Address NE 1240 Larson Blvd Belfair Zip
Contractor Self
Address Zip
Legal Description Beard's Cove Div 8 Lots 121 & 122
Direction to project site NE 1240 Larson Blvd
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1965 10x55 2 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 7
427-9670 DATE ISSUED/� 7-
PERMIT NO � �
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
Al i-L) - AJ£ /-2 VC 4avSoA, �04, , '-Luo,
DIRECTIONS
TO JOB SITE
PARCEL LEGAL p / s
NUMBER ��� DESCR Fir(-�S �Uvr �/ (/. C' fi �7 .J � � y CONTRACTOR ��-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK Ty
10
6 �t
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS�_ TOTAL SO.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
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRA N LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE NTS 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 CONF RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINI APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X WI
�
R G� DATE � �?+ +r X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENo BUILDING VALUATION e
HEALTH PUBLIC WORKS FEE
PLANNING ^ FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP - PRE-INSPECTION
('t) -I lu- i - SHORELINE
111:yvk 4, / .ra: WOODSTOVE
ec 16, 1A7: Owner contacted our department . Tank PLUMBING
as een exposed and found to be full of just water . MECHANICAL
We advised that he did tqeT have to have the tank
pumped at this time . f STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY P R IS NCE I PERMIT VALIDATION _
B CASH CK MO TOTAL
• PLOT PLAN
ADDRESS tV Je I z f-1!J 4 Q V ,CO IC, 131P L PERMIT NO. 0 o
= e
� o
LEGAL
DESCRIPTION j0 V V LOT j g BLK ADDITION AqLaY C/S
SITE AREA 2 4 YDO Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Ss 6 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'
Q �
e
v °
I/We certify that the proposed construction wiMiondses shown above and that no changes will be made without
first obtaining approval.
a w 0cv b
NAME(SI OFF OWNER(S) OF SITE TRUCTUREW (PRI ) it GNATURE OF OWNER S) OR AUTHORIZED REP ESENTATIVE
NO R/T 6ELOW THIS LINE
ROVE
DISTRICT � NOTE DATE y