HomeMy WebLinkAboutBLD4728 Final Replace Mobile Home - BLD Permit / Conditions - 7/26/1979 Green, Joel B. #4728
5-21-79
Sam B. Theler Home & Garden Tracts Tr. 1 ex S 100'
Across hiway from Belfair Auto Parts
Replace Mobile Home
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �y�'79
PERMIT NO. dl7atr
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
G )
DIRECTIONS
TO JOB SITEAeeo5 �vA -A- if D
LEGAL /J (❑ SEE ATTACHED SHEET)
DESCR. S#N1 0 � n /w IV ' � O /
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING r
Class of work: J4 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
I?Cmoklr-- /Vk o o - '
Valuation of work: $ o-d PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS__ TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. l
TOTAL SC FT. FIREPLACE ❑ DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 O F F I C E �U�E___O N LY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO.__j-- S.E.P.A.
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
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
in conforman therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY A
ROVED FOR ISS ANCE i` O Date own
I
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION e M.O. CASH
PLOT PLAN
A!DDRESS '�_PERMIT NO.LEGAL o
ANi 13 /fi`r",L 2 fro M ' G-, /, 191'N / 1 W d' It
DESCRIPTION LOT BLK ADDITION
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.)
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"ID 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.
/rj# INDICATE NORTH IN CIRCLE AA / GRAPH SQUARES ARE 5' X 5' OR 1"=20'
rI, ,
/We certify that the proposed construction will conform to the dimensions sod uses shown above and that no changes will be made without
first obtaining approval.
rl / 8 C
NAME(S) OF OWNERS) OF SITE h STRUCTURE(S) (PRINT) I NA IRE F OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELO TH/S LINE
APPROVED
DISTRICT AS NOTED DATE
6N ELTON Pii1N TANG