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HomeMy WebLinkAboutBLD2045 Final Mobile Home - BLD Permit / Conditions - 7/6/1979r Olson, William R. #2045 6-8-79 Lake Limerick Div. 4 Lot 97 Dartm000r DRive Mobile Home I ; BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATEISSUED PERMIT NO. Z.©`f 5-. OWNER NAME MAIL ADDRESS GTY 6 ST TE ZIP PHONE DIRECTIONS O JOB SITE LEGAL (❑SEE ATTACHED SHEET) DESCR. �/ 1 CONTRACTOR NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE LDescribe ork: J� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE ork: , 40 S Valuation of work: $ a PLAN CHECK FEE PERMIT FEE l-Z V ao. Of) SPECIAL CONDITIONS: BEDROOMS DECKS CARPORTO NOTICE BATHROOMS TOTAL SO. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. TOTAL SO. 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 OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT ❑ SHORELINES I I SEASONAL [] FLOODPLAIN ❑ Firm E.D. NO. 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 of the Mason County ordinance requirements for BUILDING DEPT. which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT 7 APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Own r, ��°�� � ate�` PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH PLOT PLAN ADDRESS Z'� - Q PERMIT NO. o = v LEGAL tv J ,� DESCRIPTION LOT 2. BLK '�� ADDITION, SITE AREA V.LSq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS �����.-'fir' Sq.Ft. \` INSTRUCTIONS TO APPLICANT d 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 P"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. 0INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' 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. NAME(S) OF OWNER(S) OF SITE S STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED_ 'Q DISTRICT AS NOTED DATE SHELTON PRINTING