HomeMy WebLinkAboutBLD14437 Final Mobile Home Replacement - BLD Permit / Conditions - 9/28/1983 Campbell, Robert & Sharon #14437
426-5332 7/26/83
Lake Limerick, #5, Lot 99
i
E 641 Olde Lyme Road
Mobile Home Replacement Contractor:
14'x52' , 1983 None Listed
$13,468.00
Shorelines:
Setback:
Special Conditions:
Footing:
Se tback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior :
Final: q ZY- V, 3 O
Stop Work:
Mobile Home: -3 C'
Smoke Detector: 19-z3 p_5 of(!:-
Remarks:J,uveoQ
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �� r9
DATE ISSUED
-? 6 e'.t CC -yn 4 e l/ -3
�1/� �)� f U JV jYl (ell�j / ) � Alf ZIP
OWNER �..r.i NAME.,.. J L� MAIL ARESS I 1 e F)C'� ( / &STA /l E f C1/�( ZIP �y PHONE
DIRECTIONS G / y/ / `�e C
TO JOB SITE D; It ' � G'� / L. 12.e � • `�-y�P f i C l�—� — L 1
LEGAL (❑ SEE ATTA HED SHEET)
DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
USE OF a
BUILDING / \e S ��f/VL1 4�'
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ 13,
PLAN CHECK FEE PERMIT FJ£
S. I-)
SPECIAL CONDITIONS:
BEDROOMS I DECKS _ CARPORT [ ! NOTICE
BATHROOMS_L _ TOTAL SQ. FT. GARAGE C:
r ATTACHED I' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES
77�� BASEMENT OR AIR CONDITIONING.
TOTAL SO. FT._!,� FIREPLACE ❑ DETACHED
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
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the F O OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT:PERMANENT :V SHORELINES r
SEASONALII FLOODPLAIN
Firm
E.D. NO. S.E.P.A.
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT ��-,3- s'
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
A PLICATIOC PTED BY PLANS CHECK BY APPROV D FOR ISSUANCE
Owner 7�L�1 Date . 7' A ) Y
PL CHECK VALIDATION CK. M.O. CASH PER IT VALIDATION 6K11
M.O. CASH
• PLOT PLAN
ADDRESS !— & y 0 C c[ t �i 'rn C �f� PERMIT NO. F
a o
LEGAL
0
DESCRIPTIONA 0. '5 LOT �' j BLK ADDITION u
SITE AREA �CCI X ��G� / Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS .J ( 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'
/L% c
r
V
J , i
V _
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.
2101,ilp f (,I-) A-,�np�e L-L .�>d/-/
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNERIS) OR AUTHORIZED EPRE5EN TATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6MCLTON PniNTIN."u