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HomeMy WebLinkAboutBLD12329 Mobile Home - BLD Permit / Conditions - 4/26/1982 Crouch, Robert E. , Jr. #12329 866-1427, Olympia 4/26/82 but .3-1514 Kamilche Point Road to Bloomfield Road, lst gravel road to left then right. Mobile Home Contractor: None listed $18,130.00 Shorelines - Setback: Special Conditions: Footing: Setback: Foundation Walls: Framing: Fireplace: Wood Stove: Plumbing: Mechanical: Roof: Exterior: Interior: Final: Stop Work: Mobile Home Remarks: DR�"9 i BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 y(_ R DATE ISSUED PERMIT NO. OWNER f` QM�A%� ,^� MAIL ADDRESS �� CITY 8 STATE ZIP PHONE q ' C r L ",Q (~ 0)Y AW 5 DIRECTIONS en .4 G 4 — TO JOB SITE p A) 7 �2 t' p f EC►� r 25T (�?,4UFL i� to /EAi LEGAL (❑ SEE ATTACHED SHEE 9`/C,- PHONE NAME MAIL ADDRESS CITY 8 STATE �/�ENSE CONTRACTOR /(J USE OF BUILDING Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE Describe work: , 7o- 1 o01� n,B�L� o © PPoA-410 141 70 A?7 7 rT Valuation of work: $ PLAN CHECK FEE PERMIT FF I�j '� � �S SPECIAL CONDITIONS: BEDROOMS I DECKS CARPORT �l NOTICE BATHROOMS TOTAL SQ. FT.__ GARAGE '. SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIE BASEMENT ❑ ATTACHED L] OR AIR CONDITIONING. TOTAL SQ. FT. FIREPLACE ❑ DETACHED L: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR CONTRACTOR AFFIDAVIT [ZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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 F O OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT SHORELINES SEASONAL ❑ FLOODPLAIN [J Firm E.D. NO. S.E.P.A. II By Special Approvals IN OUT YES APPROVED NO ZONING Lic. No. Date PLANNING DEPT. HEALTH DEPT. 414 J-$ OWNERS AFFIDAVIT PUBLIC WORKS I 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 jP conforr�(aa ce there MOTOR VEHICLE PERMIT �l/\ C/ PPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Owner Date. PL CHECK VALIDATION CK. M.O. CASH RMIT VALIDATION K M.O. CASH I— _ c� 9-.;?b-�s� _ __._4 PLOT PLAN ADDRESS S (�? L �jC�/Q[�//j/J/ �� PERMIT NO. o LEGAL l U N DESCRIPTION S/LSr7�iL..1 LOT �3 BLK ADDITION u SITE AREA 06) O Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS (.l.r 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 n PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION Al"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL a 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' 1-41 ! (J E J 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(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE iH6LTON PRINTING