HomeMy WebLinkAboutBLD6843 Final Mobile Home - BLD Permit / Conditions - 10/6/1980 Clark, Patrick Donald a 3 D 2 -7 5 30 #6843
7-7-80
From PXiNr Toonerville Park, go to 2nd Dirt Rd. on left,
go to Reid Sign on right, flags on left side ,of road
S 1/2 S 1/2 NE Sid --1--T3--2 _
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Mobile Home
$34,188.00
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• BUILDING PERMIT APPLICATION
r MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. (97 3
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
C7 T.REM �1J ,&.A . 47 — 150
DIRECTIONS
TO JOB SITE 700 -4%L1-C T 1 a Sr, O
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. S! OIF 0 S 0 S - 'R W W
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING4una AMkLy
L_
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Roffille Wingy-
Valuation of work: $ ✓ PLAN CHECK FEE PERMIT FEE J)
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT [] NOTICE
BATHROOMS_ TOTAL SO. FT. " GARAGE L]
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES %� BASEMENT L; ATTACHED L] OR AIR CONDITIONING.
TOTAL SO. FT''B-so FIREPLACE f I DETACHED [J
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT I i SHORELINES I
SEASONAL 1 1 FLOODPLAIN [
Firm E.D. NO. S.E.P.A. I
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. ,
PUBLIC WORKS
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. MO OR VEHICLE PERMIT
O
N>ewff
AP ATION ED BY PLANS CHECK BY AP VED FO UANCE
ner Date
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATI N CK. M.O. CASH
PLOT PLAN
ADDRESS PAT kjo,V. DOIU A LD C 1—A PERMIT NO.
cF Ttit- :S F T"E_ NIE'A a
LEGALUFSW%q ov 15ec2 —Twn;Z3W- R.�►n/W_1\
DESCRIPTION LOT BLK ADDITION u
SITE AREA ser+t. 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 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.
fi INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR " 2
C- >` N
f'
3 3'
•7 i
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(S) OF OWNER(S) OF SITE d STRUCTURE(S) (PRINT) SIGNATURE OF OWNERIS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRIT BELOW THIS LINE
APPROV D 7
DISTRICT AS NOTED DATE /
GHELTON PR:NTIN:�