HomeMy WebLinkAboutBLD28137 Mobile Home - BLD Permit / Conditions - 5/17/1991 30 ) �G
Shorelines: Plunbing:
Setback:
Mechani ca
Special
Conditions: Interior:
FINAL:
Mobile Home:
Smoke Detector:
Footing: Remarks:
Setback:
Foundation
Walls:
Fr aning:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 28137 No. Floors 1 Sq Ftg 500
Owner SUTOV H VIRGINIA Tel
Address 15227 Pine Dr Renton674 Date 5-17-91
Contracto—r---Se-M ZiP98058
Address
Legal Description 36-21-3 1Y 1 of SP 329 ip
Direction to project site 6.3 mi form shelton on h 3
�A�
DeerCr Store tltrn t
pl l n roadQ s t
P un ing Mec anica Sewer u
Fireplace Deck WO Stove
Basement (arage import
Loft Other
Q)IC('.7
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED 5�I —ell
PERMIT NO.
NAME f� MAILADDRESS CITY&STATE ZIP PHONE
OWNER
►t niaS�c /oLl �Saa �ine. PA �orl tj4__ �oSK
DIRECTIONS TO JOB SITE
n Ie llo cJ P cL pnsT &et e r e I
PARCEL ,/ LEGAL r Q b olt 1 Sf Alia
NUMBER �01 13�O_�7 �� DESCR. TR 1 0� SPA3p9 s'. 5-► e l 3 & 3
NAM MAIL ADDRESS CITY 8 STATE LICENSE NO. ZIP PHONE
CONTRACTOR �toh�,,
USE OF
BUILDING
CLASS OF WORK NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE r
WORK �
BEDROOMS DECKS YO N T "� NOTICE
T L SQ.FT.
BATHROOMS DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ.FT. TO1`AL CONDITIONING.
NO.OF STORIES SE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA `/1 a BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT_� ATTACHED
sSEAG" � — SHQRE�iidE '' DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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.
XOWNER r �TE �" XBY DATE
FOR OFFICE USE ONLY
AD DEPARTMENT YESPPROVENo DEPARTMENT YES NO
BUILDING VALUATION 0?6n
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT I
D.O.T. BUILDING PLAN CHECK '
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
C WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPR EZ. ISSZCE PERMIT VALIDATION
TOTAL
/ B CASH CK MO
PLOT PLAN
ADDRESS D PERMIT NO. s o
LEGAL A
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. SH(�W 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Y 1z
� x
1iL
.�0e) iG
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(e) OF OWNER(a) OF S1TE 6 STRUCTURE(a) (PRINT( SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE