HomeMy WebLinkAboutBLD19569 Final Mobile Home - BLD Permit / Conditions - 1/15/1987 TYPE MOBILE
Permit No. 19569 No. Floors sq Ftg 1.152
Owner GOLDSMITH, Pauline E. Tel—T77--8000 Date 11 13 8
Address 8 0 1 ,,x 5-1[. Belfair Zip 985-TT —
Contractor
Address Zip
Legal Description 17_ 2-3 Tr, 4 NW 1/4
Direction to project site NE980 Tahuya River Rd, North
Rrd t� RPlfair-Tahuya Rd rt, rt to Tahuya River Rd
PlLm bing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
------------------------------
Shorelines: I/,4 PlLunbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:/
Mobile Home:
Spoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 / C
426-5593 DATE ISSUEDTq`l
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE
Ck�y� CcrnKr� �'T..ti yK U._l��y)
LEGAL
DESCR. ICi( l i,
NAME7 MAILADDREIS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE 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
SEASONAL
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.
WNE 62 4 X BY DATE
YO E
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION '7 y
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING e FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK '
SPECIAL CONDITIONS BUILDINGGROUP - PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS C CK BY Q APPROVED FOR UANCE PERMIT VALIDATION
,LL���—c/ BY /�� CASH CK MO TOTAL
/ PLOT PLAN --
J
ADDRESS Aj, PERMIT NO. o
0�7. v
o
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA !Y! 2 nD 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Ai. y0 �FRoM Coonof—ei"
G o ro
PROP 4j E
P R 0 P0,5g D
211 qy � MOSIZ 9 Ho 4,E
S )T
r
Fk1 I p ro 3 r
r C And 0 IL
A
5 00
�c p E So MCo ME Ile or
CL AR fV o R P, I NE
o 7b P oP L/ E Ii j" N Y ,e vE A
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(a) OF OWNER(S) OF SITE 6 STRUCTURE(!) (PRINT) I NATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
I