HomeMy WebLinkAboutBLD25019 Mobile Home - BLD Permit / Conditions - 1/11/1990 Shorelines:
Setback: Plumbing:
Spec :ial Mechanics
conditions: Interior:
FINAL:
Mobile IioaMe:
Smoke ti-c Detector:
kg: `S
O Remarks:
70
S:tba
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
Permit No. 25019
Owner ND- Floors Sq Addres ORSBORN r — Tel. 7 Ftg 1568
--' a -1 90
Contractor --_
fair P
Address
Legal DescriP on Zip
Direction to projecr site
a
x 0 mi. t
1hen
take
Blacksmith Lk County Dr.
SL on main
ing C an1Ca ewier
Fireplace Deck tove
settent .oft Garage Carport
� "Other
i
1988 28x56 3 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. �C
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
LqrlCl#t f Zrl n r rSbdr a 0, /3c O ! & /A 0,rj, 9,03.-2 514.2 /o
DIRECTIONS TO JOB SITE �QE� ,•,H /p Bear C'vr, J�; d. ra (1 �►* leS 44e6c
lei
PARCEL LEGAL
NUMBER �'3/0 Q DESCR. (o (,�/ �/ ,S}�/ 2,3N A'd!(= W Al
NA E MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
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
p COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. / vo FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT , SHORELINE
SEASONAL
OWNERS FFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
CERTIFY
ION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE ENTS 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 CON RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN G APPRO L FROM THE BUILDING DEPARTMENT. 7�, APPROVAL FROM THE BUILDING DEPARTMENT.
NE DATE 02 J`4 X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATIO
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP 2, PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BYPL-L A ED F R ISSUANCE PERMIT VALIDATION 1
qo TOTAL lQ/. QG
y� .'1% � k— ® BY CASH CK MO
PLOT PLAN
ADDRESS julac-,C_�✓YI �ry 1�{iC (�Y/t/-e. PERMIT NO. ° o
LEGAL 'V' .73y AAl5 W/✓ BLK ADDITION
DESCRIPTION LOT ��
SITE AREA;4// Z5�19 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 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
If I
1
O t
� f�I
c
Gi
e ,
O �
M
1
D ra t� l
t f
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.
NAMEW OF OWNER(S) OF SITE a STRUCTURE(S) (PRINT) IG ATURE OF OWNER( ) OR AU TNORI ED R EPAESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE