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HomeMy WebLinkAboutBLD14790 Final Mobile Home - BLD Permit / Conditions - 12/7/1983 CHESTER, Matthew L. #14790 10-11-83 27-21-3, Lake Limerick, Division 5, Lot 128 Straight past Lake Limerick sign, take right onto Old Lyme Road (Before Bridge,R/R) , left onto Peebles Court, take left to Cromarty Court, 4th lot on left Contractor Self 789-6209 Mobile Home $9,000.00 Shorelines: Setback: Special Conditions: Footing: Setback: Foundation Walls : Framing: Fireplace: Wood Stove: Plumbing: Mechanical: Roof : Exterior : Interior : Final: 6',,�'/,-_ 9- r-3 Stop Work: Mobile Home: Smoke Detector : Remarks: BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 no P��_r�` /� L ' t DATE ISSUED ` L� 1' tvq CLAg1rC5Sr 5-71 CyUhlarN Ct Ur ,'Sl1gVt",�11G1791g55yPERMIT NO. I ` OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE mAEw l . 0 7 9-6.10 DIRECTIONS �,/, ``��,,. y, C�{o+C blri )railroad TO JOB SITE �j q6S� �! �'�1� 5 �MTa *ft *tic PimaQ '? LEGAL (� A Cr (❑tSEEEAATTACHED SHEET) DESCR. [_Ot Qr+y t0)UV+j q*9f Oh NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE CONTRACTOR _ USE OF BUILDING k eAAe Class of work: �K NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work:Rg0"Cl m k h �� /4 I C X (v ( q (0 Valuation of work: $ oo`/ PLAN CHECK FEE PERMIT FEE O SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT C; . NOTICE BATHROOMS___ _. TOTAL SO. FT.V40- GARAGE :1 ATTACHED I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIESBASEMENT L. Na OR AIR CONDITIONING. TOTAL SO. FT.Rao FIREPLACE f : Ka, DETACHED G 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 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 SEASONAL I I FLOODPLAIN i Firm E.D. NO. S.E.P.A. By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. Q �. PUBLIC WORKS /be y that I am exempt from the requirements of the FIRE MARSHAL ct or registration law RCW 18.27, and am aware BUILDING DEPT. Mason County ordinance requirements for this permit is issued and that all work done will ROAD ACCESS I conformance therewith. MOTOR VEHICLE PERMIT �j ©.I I 1 3 , PL ATIO ACCE E BY PLANS CHECK BY APPROVED FOR ISSUANCE Own L'L ate BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS 1 PERMIT NO. vl a 11 D D O O LEGAL �/ DESCRIPTION O LOT �IV�S\tom BILK ADDITION U r rr\\ SITE AREA a9 S Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS V Sq. Ft. lf 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 POW _3 TION THEREOF. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Cam, s V, o S -'G Z' -�, IT .j 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. mutth���- Tovce_ Chtis-4*_►- NAME(SI OF OWNERW OF SITE & STRUCTURES (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE l y SHELTON PRINTINS