HomeMy WebLinkAboutBLD7688 Mobile Home - BLD Permit / Conditions - 10/10/1977 Bennett, Terry A. #7688
10-10-77
SE 1/4 NE 1/4 36-21-3
7 miles on hwy 3 first drive on right past Agate Rd
Mobile Home
e.
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED _:�; — 7-s—12
PERMIT NO. /.2 y44
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS (�-� ' 3
TO JOB SITE .
LEGAL J
(❑ SEE ATTACHED SHEE14
DESCR. Cr7 PHONE
NAME MAIL ADDRESS CITY&STATE LICENSE NO.
CONTRACTOR
USE OF
BUILDINGe
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ ,/I ��AS/ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. `7 GARAGE []
—� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES i BASEMENT [! ATTACHED ; OR AIR CONDITIONING.
TOTAL SO. FT./� FIREPLACE 1-1 — 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 State of Washington and I the
aware of the FOR OFFICE USE O N Y
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES iJ
SEASONAL i I FLOODPLAIN iJ
Firm E.D. NO. S.E.P.A. I I
Special Approvals IN OUT YES APPROVED NO
By
Lic. No.
Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. 7q1)
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
be in conformance therewith. MOTOR VEHICLE PERMIT
` CATIONZPTE BY PLANS CHECK BY Y P OVED FOR SUANCE
Owner + Date .
`
P A CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS �'yO0 ,�CcJ�J ��J� _ [ Z_"'1 PERMIT NO. o
' o
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA �, `1y ¢ Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT
0
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- r`
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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
j�
J� P6U 144 rWWI—
�r c
Ic
I/We certify that the propos construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval. 15 �� ;).O
8
N AME(31 OF OWN I
R(3) OF 317E S STRUC TUREl31 (PRINT) IGNATU F OWNER(S) OR AUTHORIZED REPRESENTATIVE
OW DO NOT WRITE SEL THIS L NE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 /
DATE ISSUED 1,4/1 er/ -7 7
PERMIT NO.
OWNER NAME MAIL DRES CITY& E ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL O S ATTA SHEET)
NAME MAIL A DRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: y�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ /a �/� '7 --c PLAN CHECK FEE PERMIT FEE a
1 7 cX a
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY ABYP Fp FOR I ANCE Type Const f �7�7 Occupancy Division
C � 1 / /
Size of Bldg. No. of Max.
(Total) Sq. Ft./Ve,5�, Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in onformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
_ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
0 er Date. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH