HomeMy WebLinkAboutBLD20924 Mobile Home - BLD Permit / Conditions - 9/18/1987 Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile
Smoke Detector:
Remarks:
ooting
Setback:
Foundation
Walls:
Framing:
Fireplace: -NULL
Wood Stove: DATE /-9-?/ RV
TYPE MOBILE HOME
Permit No. 20924 No. Floors Sq Ftg 860
Owner SMITH, Barry Tel 830-9223 Date 9-18-87
Address 28 Gold Crk. Rd NW Bremerton Zip
Contractor None
Address Zip
Legal Description N-1 2,NW,NE,SW 4-23-2
Direction to project site West on Bear
Cr.-DeWntto, 1pff
at end of pavement, lst rt. , 1st rt. , end of rd rt side
Erickson Lake Tracts
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1969 20x43 2 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 O
426-5593 DATE ISSUED Z-
PERMIT
NAME SLA h rti MAILADDRESS CITY&STATE ZIP PHONE
OWNER
r rV J m i t' F Go>d C-4. RA.N.V. e�r,e��f W ��f�3/.� k30 - ,?.)3
DIRECTIONS I / 4 Q f'll t rd -Pj'rs -r�9� /r i rSf�,Jc{,�en `o-PfPcta� r AfSi�Q
TO JOB SITE W ph Be.Rr(rk-,0el✓u 0 Lei u uvNh+en Q a 9 V�
Cri CKSO h Luke Tea G/S
PARCEL e LEGAL IV' -4 � C S, El
NUMBER � ,7 DESCR. See OL#,XI C,C
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTORUSE OF
f
BUILDING �lnr !1 S (�C'nC e
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE rr t I`_/ //
WORK LrLG/ (�oUO/c? W/C�C� m �^{�,�� /�c,nL aQ XyJ v uNrt1� f'/�Lh 1/ �C%
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
REdISTRATION 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 TI.1F BUILD N DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
,mac I- 61(
XOWNER� ATE XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH >� PUBLICWORKS FEE
PLANNING FIRE BUILDING PERMIT ! !�
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY P APPR PERMIT VALIDATION
B CASH CK Mo TOTAL 76
PLOT PLAN
ADDRESS IL`CiS��+
L (� � PERMIT NO f o
= o
n >
LEGAL
DESCRIPTION LOT BLK ADDITION 1-_ 0 Q 1
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS S vr—) Sq. Ft. Z
PPR-e,;I,c 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
u
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.
'F" INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
/!0%
_4 0.
.r 3
13
c
R
R
S
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be IT ide without
first obtaining approval.
ck r 5 tk5 art �m 1 �-
NAME(S) O OWNER(S) OF SITE 6 STRUC TURE(SI (PRINT) IGNATURE OF O RISI OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED i
DISTRICT AS NOTED lk DATEO'A'�