HomeMy WebLinkAboutBLD15471 Final Mobile Home - BLD Permit / Conditions - 6/19/1984 BURDICK, John G. #15471
5-1-84
Lake Limerick, Div 4, Lot 116
22023 llth Ave So. .
Des Moines, Wash 98188 824-3383
At entrance to Lake Limerick, turn right at Fire Sta-
tion to Ballbrigan Rd. Go left, see sign on property.
Contractor
None listed
Mobile Home 1983 24x54
$23,976.00
Shorelines:
S e tba ck:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final: 0k-'
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY '
P.O. Box 186 Shelton, Washington 98584 -
426 5593 R`-�- f�l/
DATE ISSUED `, T
PERMIT NO. � 7/
OWNER NAME MAIL ADDRESS CITY 3 STATE ZIP Z PHONE
�o L 5 OO Y
DIRECTIONS (,L7` -2.H Y /ZGl.tit e !v �Ae r L�`s-rJ G,1 �'C� �L) AV G4) d -
TO JOB SITEI L oecz, Agef--d,4
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. L Loc>/2�Zk ,D!Ui .?�-r Le�'` !� ,(
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
USE OF
BUILDING Vag;,
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $����� � PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS_ DECKS CARPORT I I NOTICE
BATHROOMS TOTAL SO. FT.-- GARAGE
/ ATTACHED i SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [_: OR AIR CONDITIONING.
TOTAL SO. FT/ FIREPLACE f DETACHED L:
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
r WORK IS COMMENCED.
I certify/'that I am a currently registered contractor in
the Soto of Washington and I am aware of the FOR/OFFICE OFFICE USE ONLY
ordin ce requirements regulating the work for which
the ermit is is the
and all work done will be in
con rmance therewith. PERMANENT SHORELINES
SEASONAL I FLOODPLAIN
Firm E.D. NO. S.E.P.A. f
By Special Approvals IN OUT YES APPROVED NO
Lic. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. r'
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
4in
permit is issued and that all work done will ROAD ACCESS
ormance t with. MOTOR VEHICLE PERMIT
ICATI ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Own _� DateIje, . " J -`� BY
PL<N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. 4 0
n D
LEGAL
OESCRIPTIOAI Is
LOT �L 9 BLK C ADDITtONLG� , C—/41/C.l;'C/� u
SITE AREA 1 OC Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS C7 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 Al"D 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'
r
a
1
I/We certify that the proposed construction will conform to the dimensicYns and uses shown above and that no changes wil be made without
first obtaining approval.
1111rY e5 e
NAMES) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) I NA RE OF OWNER(5) OR TH IZED REPRES NTA E
DO NOT WRITE SELO HIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRTNTIN3