HomeMy WebLinkAboutBLD12146 Final Mobile Home - BLD Permit / Conditions - 6/24/1982 Gantt, .Tokn 4�12146
(373-2778) 3/16/82
Tiger Lake Rd. , past Toonerville to Blacksmith #17,
on Right.
Blacksmith Lake Acreage Tracts, Divisiion 1, Tract 17,
3 13-2. N
Mobile Home Contractor:
None -Listed
$25,900.00 oa 0
Shorelines:----
Setback: —`
Special Conditions:
Footinq
Setback: _
Foundation Malls:
Framinq: --
Fireplace:
Wood Stove:
Plumbinq:
Mechanical:
Rood: -------
Exterior:
Interior:
Final: C All
Stop Work:
Mobile
Remarks: —
yam--- -- -.�
BUILDING PERMIT APPLICATION
i
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
�3-16 8�
� DATE ISSUED
'��TT PERMIT NO.
off 6 ,� w
OWNER NAME MAIL ADDRESS CITY 8 STATE 3�2 ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL —' '� �( ' .� / - '? (❑ SEE ATTACHED SHEET)
DESCR. , L'/
CONTRACTOR NAME MAIL ADD SS CITY S STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: 31NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
60
Valuation of work: $��S PLAN CHECK FEE PERMIT FE'* 4so
87
SPECIAL CONDITIONS: rl1
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES-— BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. J V 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 FO OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in 71
conformance therewith. PERMANENT i SHORELINES
SEASONAL ❑ FLOODPLAIN I_]
Firm
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. L 9
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 in conformance therewith. MOTOR VEHICLE PERMIT
r APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. 1 y / BY
DIV P CHECK VALIDATION CK.. M.O. CASH p PERMIT VALIDATION CK) M.'O/. CASH
I
• PLOT PLAN
ADDRESS PERMIT NO. o
A >
a o
LEGAL
DESCRIPTION LOT BLK ADDITION u
SITE AREA 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 ARID 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.
0 INDICATE NORTH IN CIRCLES O GRAPH SQUARES ARE 5' X 5' OR 1"=20'
r
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17
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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 i STRUCTUREW (PRINT) ATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING