HomeMy WebLinkAboutBLD21850 Final Mobile Home - BLD Permit / Conditions - 5/4/1989 aa3 ld - �� od3sc�
Shorelines: A/,4 Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile ome:
Smoke Detector:
Remarks:
Footing:
setback:
Foundation
Walls:
Framing:
Fi replace:
Wood Stove:
TYPE MOBILE HOME
permit No. 21850 No. Floors Sq Ftg 1680
Owner ZWAN, Lanny Tel 830-4852 Date 4-22-88
Address P O Box 2858 Silverdale Zip
Contractor None
Address Zip
Legal D=scription Tr 35 NW,SW 10-23-2
Direction to pro jec sl e Out Bear Creek Rd to Black-
i h Lk Dr turn left follow to last lot on left
Plunbing MechanicaL Sewer Ttbod Stove
Fireplace Deck Garage Carport
Basement Loft Other
1988 28x60 3 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUEDV'�C--�?-C��
ZC71'2/7 zzwegI-) PERMIT NO:,
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONELAvkk
DIRECTIONS
TO JOB SITE
PARCEL LEGAL A . _ 2 /�� r)
NUMBER Z lZiD "7.6 oo3S0 DESCR. �� Iv�AY N ('� {(3 v2sf /WC-y 2
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK
l
x
BEDROOMS DECKS CARPORT NOTICE
.!� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS !.i TOTAL SO.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 SO.FT./4rXe-) FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSAFFIDAVIT 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
REGISTRATI N LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREM TS 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 CONF MANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OSTAININ APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OkVN DATE "?AAet sps X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENo BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING 1 FIRE BUILDING PERMIT
D.O.T. BUILDING 'S PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP r7=3 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE y
APPLICATION ACCEPTED BY PLANS CH K BY APPROVED FOR ISSUANCE [PERSHIT VALIDATION
�� c BY ;dr( A CK MO TOTAL 7�'
PLOT PLAN
ADDRESS N_^- J rra ((-K) OP, PERMIT NO. 4 0
�S N�� �p�� '�'4� - Twn� 23 IU
°o
LEGAL `� (A� f�L1v� Z2310 76 () 3S�
DESCRIPTION LOT BLK ADDITION
SITE AREA 2'-t1, -Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
T INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"a20' 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 Q
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 POW
TION THEREOF. '
0'
0
I V'
INDICATE NORTH IN CIRCLE -7f' GRAPH SQUARES ARE 5' X 5' OR 1"=20' v'i
G)
_o
l�
I/We certify that the proposed construction will conform to the dimensidns and uses shown above and that no changes will be made without
first obtaining approval.
NAME(a) OF OWNER(S) OF SITE 6 STRUCTUREM (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE