HomeMy WebLinkAboutBLD14923 Final Mobile Home - BLD Permit / Conditions - 1/5/1983 FINTON, Jerry L. #14923
11-10-83
O4
W--23-2, Tract 29 of Survey 7/17 except
Deft on Blacksmith Lake Road off Dewatto-Bear Creek Rd.
to Lot 29-B
c
Contractor
Self 275-4040
Mobile Home
$11,550.00
i
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior :
Interior :
Final: 3
Stop Work:
Mobile Home:
Smoke Detector :
Remarks:
I
-BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �_ O _g'
DATE ISSUED L�
PERMIT NO. "? a
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
3 3 �-a _ 7s-y��-
DIRECTIONS
TO JOB SITE �rf� c S ` dew. rl TO LT 0 2_13
LEGAL /d D-3•— (❑ SEE ATTACHED SHEET)
CONTRACTOR
NAME AIL ADDRESS CITY&STATE LICENSE NO, PHONE
Sp �
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ,^ ^ � � 1 n� 14
3 '16d,
4 6 ( a . s o
Valuation of work: $ ,�7•e� PLAN CHECK FEE PERMIT FEE 4
-z s
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE f_]
ATTACHED 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED 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 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 LL SHORELINES 1 1
SEASONAL ❑ FLOODPLAIN
Firm E.D. N0. S.E.P.A. Ll
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
4this
am exempt from the requirements of the FIRE MARSHAL
gistration law RCW 18.27, and am aware BUILDING DEPT. /d Q
n County ordinance requirements for
rmit is issued and that all work done will ROAD ACCESS
ance therewith. �/jMOTOR VEHICLE PERMIT
_ Date r l(1�� p" �( 3 APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
CAN, CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN 14
C r
ADDRESS ' J - � — �� PERMIT NO. ` -
0
= o
n >
a o
0
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA 2-L>r- CJ y
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 Al"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.
L V
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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 OWNE (S) OF SITE h STRUCT REIS) (PRINT) SIGN TORE F ER(S) OR AU THORI Eq REPR EN TA TIVE
DO NOT WRITE BELOW THIS LyFE
DISTRICT AS NOTAPPROVED ��) 9.
A//oAr DATE Qt l
SHELTON PRINTIN3