HomeMy WebLinkAboutBLD9016 Final Mobile Home - BLD Permit / Conditions - 12/30/1980 Van Deg Meer, E. M. #9016
11-7-80
West on North Shore Rd. to Lynch Cove/Beard's Cove
Bndry. - Up hill on Larson Lk. Rd. 200' past Trouner
Bldv.Beard's Cove, No. 8 Z07- ,✓'/
9
Mobile Home
$11,429.25
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BUILDING PERMIT APPLICATION
COUNTY
1 MASON
0
I +� P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER AME MAILADDR S CI ESTATE ZIP PHONE
E a. BOY.. 0 ll �� BS�2 Z
DIRECTIONS .
TO JOB SITE LJ�ST O� o.�y0/ZE Well .UP' a,J I �tU
LEGAL /�� Q �J(El SEE
/ATTACHED SHE
DESCR. L4� /�F ,f GG f 1Io• O OL /p z'Aj
AME MAIL ADDRESS C d STATE LICENS NO. PHONE
CONTRACTOR
f o- 8 3 ce
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work: __//
f - CE �LoC
Valuation of work: $ i PLAN CHECK FEE PER FEE
14 � 2
SPECIAL CONDITIONS
BEDROOMS_ DECKS CARPORT ❑ NOTICE
BATHROOMS__. TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ 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. PERMANENT11 SHORELINES ❑
SEASONAL f, FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. 13
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
ontract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County rdinance requirements for
which this permit is i and that all work done will ROAD ACCESS
be In conf anc t re ith. OR VEHIC E ERMIT
AP ICATION TED BY PLANS CHECK BY APPR ED FOR I UANCE
Owner 0c,
Date BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO.
: o
LEGAL
DESCRIPTION LOT `J BLK ADDITION
SITE AREA ' Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS r 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 A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SE yICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EA BUILDING AND MAJOR POR-
TI
If DICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
1&qE
w
(s
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no anges will be made without
first obtaining approval.
Cc
NAME(S1 OF OWNE (71 OF SITE b STRUCTURE (PRINT) IGNATURE OF OW R OR AUT D REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3