HomeMy WebLinkAboutBLD0574 Cancelled Mobile Home - BLD Permit / Conditions - 1/9/1991 Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile cme:
Smoke Detector:
Remarks:
noting
Setback:
Foundation
Walls:
Framing: PERMIT ATMN
Fireplace: NULL
Wood Stove: YE ICY __ --- ----
TYPE MOBILE HOME
Permit No. 0574 No. Floors Sq Ftg 720
Owner MAUPIN, Alice E Tel Date 9-29-87
Address E 531 Old Lyme Rd Shelton Zip
Contractor None
Address Zip
Legal Description Lake Limerick Div 5. Lot 103
Direction to project site Lk Limerick Rd left on Old
Lyme Rd to 531 Old Lyme Rd.
Plumbing C anica ewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1972 12x60 2 bdrm
y �
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 *ATE ISS IT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
� J It
DIRECTIONS
TO JOB SITE ,I
Y`'� (Z � J e Lys
PARCEL LEGAL
NUMBER DESCR. Q3 Vb/>_1 I()\`
NAME MAIL ADDRESS CITY&STATE LICENSE NO. IP PHONE
CONTRACTOR s �� 2 l-"i � 2� .tit , �j
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE Q
WORK Y V ry-\ �� �) V� C�'� Jlz-O l� IX
BEDROOMS ` DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES __L BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. 72U FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. (�� APPROVAL FROM THE BUILDING DEPARTMENT.
WNER4'' �� ���_C `D� ��_ - X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION �
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT �-
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP _ PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY F S E PERMIT VALIDATION
TOTAL
CASH CK MO s
PLOT PLAN
ADDRESS PERMIT NO. f o
LEGAL
DESCRIPTION �I -?� LOT BLK ADDITION
SITE AREA �C"7 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 AND 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'
O)_D 1'y tvx c �17, 110- 1 X
I
74,
✓J
P` I 1
tj
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.
CE �.
NAME(S) OF OWNER(!) OF SITE STRU TUR ) (PRINT) 9IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
O V E D c �6� ✓' / �'—
DISTRIC SNOTED %C.- -� DATE /
�� �/