HomeMy WebLinkAboutBLD134 Final Mobile Home - BLD Permit / Conditions - 10/2/1979 Watson, Robert W. #134
8-10-79
Div. S Lot 91 Lake Limerick
Right on Old Lyme Rd. Turn left at Kilmarnock.
Mobile Home Contractor
Auburn Mobile Home, Inc .
$13, 000.00
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED ! 7 9
PERMIT NO. 4
OWNER NAME MAIL ADDRESS r3OX It CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE QL D _r E
LEGAL + �.L (❑ SEE ATTACHED SHEET)
DESCR. I A D ' C
CONTRACTOR ME MAIL ADDRESS CITY& TE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:. ` ,/ d
Valuation of work: $ PLAN CHECK FEE PERMIT FEE ^�
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT Ll NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED L 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ElDETACHED fa
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 1
SEASONAL I I FLOODPLAIN 1 1
Firm E.D. NO. S.E.P.A. LJ
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
be in conforman a therewith. MOTOR VEHICLE PERMIT
Or Date. �{/d— 79. A LIGATION ACCEPTED BY PLANS CHECK BY AP ROVED FOR ISSUANCE
� 1 -A, p/,/-4&�PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH
PLOT PLAN
ADDRESS PERMIT NO. O o
io
n >
a e
LEGAL
DESCRIPTION LOT BLK ADDITION u
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.
INDICATE NORTH IN CIRCLE / GRAPH SQUARES ARE 5' X 5' OR 1"=20'
170
G
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I/We certify that the proposed construction will conform to the dimensicr+s and uses shown above and that no changes will be made without
first obtaining approval. 01
NAMEM OF OWNER(3) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PMNTIN3