HomeMy WebLinkAboutBLD26837 Mobile Home - BLD Permit / Conditions - 10/1/1990 l a.331-
Shorelines: Plunbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE f10BI E HOP9F
Permit No. 2ti2-�7 No. Floors I Sq Ftg 110A
REE
Owner 6W ETI A ,, r Tel 275_�a�s Date 1 n_1
Address an 8oY �7 Tal��i� a 1J/� Zip
Contractor
Address Zip
Legal Description
Direction to project site w, Sl Qr-Q Rd to Bann Hi 11
w6 R I ^n R1vd 6 en 6�rsen �� P� R en Savor nr
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P um ing Mechanical Sewer Wood Stove
Fireplace Deck age arport
Basement soft Other
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED / V
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY STATE ZIP PHONE
O S>
DIRECTIONS
TO JOB SITE
,J
PARCEL LEGAL
NUMBER g DESCR.
NA"E MAIL ADDRESS CITY 6 STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF WORK W ADDITION ALTERATION REPAIR MOVE REMOVE
r
DESCRIBE
WORK
BEDROOMS 3 DECKS YOF& CARPORT NOTICE
TOTAL SQ.FT. 1-0
BATHROOMS — DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SO.FT. TOTAL SQ.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. It vy TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE Vue? 1ATTACHED 1'-4 _
SEASONAL I SHORELINE DETACHED _
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY TH I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATI LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREM TS 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 CON RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
NE DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION OD
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
c
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP j LE_ PRE-INSPECTION
' SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK SYY APPR D F q ISSUANCE PERMIT VALIDATION
CASH CK MO TOTAL
PLOT PLAN
ADDRESS y � o4t174 oL�Zi JL/�;'D� i� PERMIT NO. 4
s o
o
LEGAL �
DESCRIPTION r
I�hJ'19016'LL� � — � O BLK ADDITION u
SITE AREA IL--� X �D Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS X LI(u Sq. Ft. R r�
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'
Iap
1
-3
L
5
.y
c�
I/We certify that the proposed construction will conform to the dimensi"and own above and that no changes will be made without
first obtaining approval. W.,
NAMEW OF OWNER(SI OF SITE & STRUCTUREM (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE