HomeMy WebLinkAboutBLD15071 Final Mobile Home - BLD Permit / Conditions - 2/21/1984 LAFERRIERE, Lea E. #15071
1-10-84
Tract C SE 1/4, SE 1/4 31-21-3 Short Plat 1305
P.O.Box 1323
Shelton, Wash.98584 Contractor
Self
Mobile Home 426-9774
$21,312.00
2 miles out Brockdale Road. Next
to Shelton Screw.
. . . . . . . . . . . . . . . .
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Aoof:
Exterior :
Interior :
Anal:
Stop Work:
Mobile Rome:
Smoke Detector :
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. 7/
OWNER E MAIL ADDRESS CITY&STATE_ ZIP PHO
N M
DIRECTIONS p` ........ .} (� 1
TO JOB SITE rn /E5 Ot/ C k F-I f0 J hA:I/D/L ---
LEGAL /� / �`/ (❑ SEE ATTACHED HEET)
DESCR. ��LZ e T 71Q
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING ycl17)r ? �
Class of work: VNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: / �^ �,/ /c � � � /ram /
Valuation of work: $ AN CHECK FEE PERMIT FEE 7
4�1,a�
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT G NOTICE
BATHROOMS �L TOTAL SO. FT. GARAGE i'
ATTACHED C SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE f 1 DETACHED Ll
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 18QOAYS,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 FOROFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
.00 SEASONAL (-, FLOODPLAIN 11
Firm E.D. NO. S.E.P.A. 1;
By Special Approvals IN OUT YES APPROVED NO
Lic. No,�— Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
1 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 conforma_nce therewith. MOTOR VEHICLE PERMIT
Y
Owner
/9S(� APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
-�'� ate � r/ �
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMIT NO. ISO
f o
i o
D
D O
O
LEGAL
DESCRIPTION L LOT BLK ADDITION
SITE AREA J Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. \
Q
INSTRUCTIONS TO APPLICANT V,
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.) R�
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF y
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION Pl'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL T.
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF. /7)
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
C � E
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.
NAME(S) OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) IGNATURE OF OWNERS) AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PRINTING
I