HomeMy WebLinkAboutBLD23794 Mobile Home - BLD Permit / Conditions - 5/26/1989 Shorelines: Plumbing:
Setback:Special Mechanics Interior: :
Conditions: FINAL:
Mobile ome:
Smoke Detector:
Footing: Remarks:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 23794 No. Floors
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g �Owner SWISHER, i ism Tel48 Date 5-26-89Address
Contractor American 110DI I e Humes n Zip-
Address Lacey
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Legal Description r urvey - - P
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Direction to
ect site
P J ou mi .
Mason Lk Rd.Turn left, turn rt. down to "Y .wo straight
ahead 1st drive on ri ht
un ing c anica ewer tove
Fireplace Deck a— a Car
Basement Loft Otherg Port
1989 28x44 3 bdrm
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUEIJI—�:``?6 2
PERMIT N0.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE ,y
OWNER / S i5A �e 0-
DIRECTIONS tg6ow' N. 4wy 3 ro tor. Tc,,ep C•eFT. T(i�Q,c� /�
TO JOB SITE rtj S7` d .0
d c—- TO y �N Rd• qo STieAighT / s7` (gQiu -e- 4.,A 7`o 7-A ePARCEL
NUMBER L �/3d DESCR. %r A CT / -3 yam[/ y 3 � a i .3
3�i3 17 b
CONTRACTOR
NAME - M4�ILADDRESS ITY&STATE LICENSE NO. ZIP PHONE
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USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ v
DESCRIBE
WORK m O 6/L-e .p
BEDROOMS_ DECKS �_ CARPORT`S—' NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS_ TOTAL SQ.FT. `"'" GARAGE `-� CONDITIONING.
NO.OF STORI ES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTALSQ.FT. // 7j FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERM ENT ,i/ SHORELINE
SEAS AL
OW ERSAFFIDAVIT CONTRACTORS AFFIDAVIT
I C IFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REG TRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQU REMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YEAPPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING WA- PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE ,
APPLICAT N ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION n `
TOTAL
BY� CASH CK MO
PLOT PLAN
ADDRESS PERMIT NO. s o
= s
n >
s o
0
LEGAL
DESCRIPTION LOT BLK ADDITION
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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 AND 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.
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I INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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.
ElS) OF OWNER(S) OF SITE a STRUCTURE(!) (P INT) T� SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE