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HomeMy WebLinkAboutBLD2043 Mobile Home - BLD Permit / Conditions - 6/6/1979 James Davis' C. #2043 6-6-79 Lake Limerick Div. 4 Lot 111 Mobile Home yy2o�.l.o-e:�:.�.,o.�C,� yl� .�.,.,w,� ,. BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 / DATE ISSUED 7 g PERMIT NO. 4;&1 OWNER ME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS TO JOB SITE LEGAL / i (❑SEE ATTACHED SHEET) DESCR. I C1' ©1 L /���£t / d( D U i✓L G NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE CONTRACTOR ± 0_T 12 kV, 11 N I� A, USE OF l` BUILDING � Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: i r Valuation of work: $ Q¢O 0—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. TOTAL SO. FT. I' UR 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 l l SEASONAL)e FLOODPLAIN Ll Firm E.D. NO.—;el 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 per issued and that all work done will ROAD ACCESS Si conforma ce erewith. ,+ MOTOR VEHICLE PERMIT ns APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Owner i( Date: r PLAN CHECK VALIDATION CS) M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS PERMIT NO. f o i a LEGAL n > A O DESCRIPTION LOT ( ( %6K L ADDITION f� ���Iyl /�l(/f_ " u SITE AREA C 0L Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS L 0 Sq.Ft. n 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 SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. r INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' r i I� n C IZ I 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. 4%C-- < AME(3) OF OWNER(!) OF 31 E 6 5TRUG'rURE(3) (PRINT) SiGNA URE OF OWNERS) OR A REPRES NT IVE DO NOT WRITE BELOW THIS LINE APPROVED TRICT AS NOTED DATE ICLTON PRINTIN3 — — -- -- ,