HomeMy WebLinkAboutBLD18729 Mobile Home - BLD Permit / Conditions - 6/4/1986 2� 75_ BUILDING PERMIT APPLICATION
3W ' -6o 1 MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS4/ 71-e,, ` �T�Ya ATE ZIP PHONE
OWNER / ST L LL S �� T.uJ, �cv LT' /sL9�D,
d o?7T
DIRECTIONS
TO JOB SITE /�OG/QS�GT/z�/✓ QT- GL�i9/�1P\\��I�U RL -�/li) L-�Fi7t"d �•
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTORUSE OF
/BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
BEDROOMS DECKS CARPORT__________ NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
N741-
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAN"I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATIO 'LAW PC 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREME S 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 CONFO ANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA IN APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
OWNER +c�'I �Laqll DATE ` un I9F(Ll - X BY - _ DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO i
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY 4PIP 5kE SUANCE PERMIT VALIDATION
CASH CK MO TOTAL �`3, 7`
PLOT PLAN
ADDRESS i 1; / y� fJ�L.�/9/��/� „�r ���/�L> ERMIT NO �� \o
1 � p
LEGAL _ S�%/E'✓ � � �° �^
DESCRIPTION LOT "TL— / BLK ADDITION a
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
r.
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 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
jr-
IL
II
72 MPo (
I1
r
V
11We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without G
first obtaining approval.
AME(S) OF OWNER(S) OF SITE ! STRUCTURE(!) (PRINT) SIGNATURE OF OWNERISI OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE 49
TRICT AS NOTED
LTON PRIN7IN3
TYPE MOBILE HOME
(Permit No. 18729 No. Floors Sq Ftg 720
'Owner HILLIS. Esther L. Tbl 372-2772 Date 6-4-86
Address NE 7600 Belfai_r Tahuya Rd. Tahuyya _ Zip
Contractor Ho,E,
Address Zip
Legal Description 2-22-3 Por SE,NE
Direction to project site Intersection of Belfair Tahuya
Rd. and Dewatto Rd. Near Tee Lake
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1971 12x60 2 bdrm.
Shorelines: Plumbing:
Setblck: Mechanic
Special Interior: .
Conditions: FINAL:
Mobile Home:
Smoke Detect .
gg Remarks:'
Setback:
Foundation
Walls:
Framing: nco
Fireplac vn�n RY EXPERATIO
Wood Stove:
By
DATE -----