HomeMy WebLinkAboutBLD15840 Final Mobile Home - BLD Permit / Conditions - 8/15/1984 PETROWSKI, John #15840
7-16-84
Lake Limerick, Div. 5, Lot 95
E 120 Catfish Lake Rd.
Shelton, Wash 98584 426-6924
Mason Lake Rd. to Old Lyme Rd. (E731) fir st rd. to
right before tresle
Contractor
Dietz Kadoun
Mobile Home 24x48 1984 3 bdrm.
$21,312.00
Shorelines:
Setback: 6 !�
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical: ,
Roof:
Exterior:
Interior:
Final: f,4 C--
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
I L-le L* "If 26 6 z
DIRECTIONS r /� �- /�
TO JOB SITE M�� k4kg taro /(e� l �73� /'//1 T/CB/�/ /d P / �EFO Wes
LEGAL / (❑ SEE�ATTACHED SHEET)
DESCR
NAME MAIL ADDRESS, CITY&STATE LICENSE NO. PHONE
CONTRACTOR �F
USE OF
BUILDING �C-'
Class of work: XNEW ❑ ADDITION ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
r:P� / IS-2- S -77
Valuation of work: $ / PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS _ CARPORT LJ NOTICE
BATHROOMS__- TOTAL SO. FT. GARAGE i I
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L7 ATTACHED C OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE I 1 DETACHED
Ll 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 ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the Mate of Washington and I aware of the FOR OFFICE USE ONLY
ordi�iance requirements regulating the work for which
the permit is issued and all work done will be in
r� co formance therewith. PERMANENT � SHORELINE
/ SEASONAL ( FLOODPLAIN
Firm E.D. NO. S.E.P.A. IJ
Special Approvals IN OUT YES APPROVED NO
VLic. N Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. D
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
b conf manc erewith. MOTOR VEHICLE PERMIT
�J PLICAT ON ACCEPTED BY PLANS CHECK BY I APPROVED FOR ISSUANCE
Owner Date _/ /�' 40' G�. C` � 'G E l L_
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
231 �VL� 20 �
ADDRESS PERMIT NO. f o
= o
LEGAL Q /// Y
DESCRIPTION LOT ! S ' /K `� ADDITION U
SITE AREA —Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 1 �S 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"'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. I� \
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' \�
`IJ
�r
V.
n
I
In l
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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.
F n%li' LL
J old
NAME(S) OF OWNER(S) OF 31TE h STRUCTUREIS) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PRINTIN3