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HomeMy WebLinkAboutBLD14836 Mobile Home - BLD Permit / Conditions - 10/19/1983 SIBBERT, Keith & Jeanna Marie #1.4836 10-19-83 30-23-1, Beards Cove, Div #8, Lot 133 Same Contractor Self 275-0898 Mobile Home $17,094.00 Shorelines: Setback: Special Conditions: Footing: Setback: Foundation Walls : Framing: Fireplace: Wood Stove: Plumbing: Mechanical: Roof: Exterior: Interior: Stop Work: Mobile Home: Smoke Detector : Remarks: 1 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 f 0 DATE ISSUED t PERMIT NO. OWNER AME MAIL ADDRESS CITY 8 STATE ZIP PHONE F_ T Slalsalzr c), x 78 BrELFAIQ A 9' DIRECTIONS TO JOB SITE LEGAL /� 6 c� s ( ATTACHED SHEET) DESCR. L0T (33 " G'ICAO-7 o; $ AS 1'F_A 'PLAT THcV'ror '1z6--00RSAt'-b ('/d'.twtC- NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING I-R-is 11 za N C$ Class of work: P'ITEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE [] REMOVE Describe work: 1t\ '104 Valuation of work: $ ` © � PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: BEDROOMS I DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SQ. FT. GARAGE ❑ ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. TOTAL SQ. FT. FIREPLACE ❑ 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 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 F F I C E USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT SHORELINES X SEASONAL ❑ FLOODPLAIN ❑ 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. Z PUBLIC WORKS Zein am exempt from the requirements of the FIRE MARSHAL istration law RCW 18.27, and am aware BUILDING DEPT. n County ordinance requirements for mit is issued and that all work done will ROAD ACCESS ance therewith. r� MOTOR VEHICLE PERMIT _ ` JL"� 9S2 LIGATION CCEP B PLANS CHECK BY APPROVED FOR ISSUANCE Owner �� ��1�__ Date . V_Jil _� t!r �O) BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS C)3, 6 L—Ar' bt%1 _8)­1iD PERMIT NO. 14 9 o n s s o `o LEGAL n DESCRIPTION LOT I R,�Couc WCB BLK ADDITION _ u SITE AREA U� Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft. $ 70 INSTRUCTIONS TO APPLICANT �A_ THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE Z FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) A FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- f SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- La C TION A"'D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL d SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. ll INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' P _A � y LA, JS r i 1 A I � f I/We certify that the proposed construction will conform to thn-flimensivns and uses shown above and that no changes will be made without first obtaining approval. PQXME(S) OF OWNER(S) OF SITE & STRUCTUREM (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZE REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DATE ` 9� _ DISTRICT AS NOTED SHELTON PRtNTIN3