HomeMy WebLinkAboutBLD1620 Final Mobile Home - BLD Permit / Conditions - 3/17/1975 Dail , Fred M. #1620
3/17/75
Lake Limerick, Division #5,' Lot #43
Mobile Home
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D/31 L F/�ED. M.
BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washington 98584
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DATE 3VL;2V L3 _
Applicant to complete numbered spaces only. PERMIT NO.
JOB ADDRESS
LEGAL F4O T
1 OESCR. / [T \� (QSEE ATTACHED SHEET)
OWNER MAIL ADDRE33 ZIP PHONE
2 9 dad)ot wa- ' S1 sl
CONTRACTOR MAIL ADDRESS P ONE LICENSE NO.
3ARCHITECT OR DESIGNER ` / MAIL ADDRESS NELICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUILDING
1 t �^
L
8 Class of work: *NEW ❑ADDITION ❑Al TERAT ON ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work: LZ A/,n,� ' 6 �
10 Change of use from
Change of use to
11 Valuation of work: $ //J oD/1 PLAN CHECK FEE MIT FE PER E O�U
SPECIAL CONDITIONS: C/ Type of Occupancy
Const. Group Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY PLANS CHECKED BY APPPR/OVED FOR ISSUANCE BY Zone Zone Required ❑yes ❑NO
Units
�L�6(L
No. ofOFFSTREET PARKING SPACES:
Dwelling Covered Uncovered
N O T I C E Special Approvals Required Received Not Required
ZONINC.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT. A
HEATING, VENTILATING OR AIR CONDITIONING. `f
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (SDeclfy)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
SIGNATURE OF CON TR CTOR OR AUTHORIZED AGE (DATE)
SIGNATURE OF WNER IF OW ER BUILDER DATE)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.� M.O. CASH
i
- PLOT PLAN
ADDRESS PERMIT NO. f o
LEGAL
DESCRIPTION LOT 7 ( BLK ADDITION
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SITE AREA j Q LJ Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS / Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCNLE 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5:X FOR 1"=20'
2. 2
c — 6
s �
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 & STRUCTURE(S) (PRINT) SIGNATURE OF OWN ER(S) O AUTHORIZED RZIESEI"ITATIVE
DO NOT WRIITTEE BELOW THIS LINE
APPROVED z
DISTRICT AS NOTED r ,//,L.�c-- DATE
GREET ON PVZIN711-