HomeMy WebLinkAboutBLD15241 Final Mobile Home - BLD Permit / Conditions - 4/24/1984 DE LOST, Ronald #15241
3-9-84
Blacksmith Lake Acreage Parcel 22
9-a 3
P. 0. Box 5027
Belfair, Wash. 98528
Contractor
Harbor Mobile
Homes
7 miles up Bear Creek-Dewatto Rd.
Left on Blacksmith Rd, 2-1/2 miles to Lot 22
Mobile Home
$23,088.00
i
. . . . .
Shorelines:
Setback: e,,�<
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace: ,
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior :
Interior :
Final: 1,E-(j75,47771 7
Stop Work:
Mobile Home:
Smoke Detector :
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY -
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER ? NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
Ce
E ' A_
DIRECTIONS
TO JOB SITE
LEGAL ( EE ATTACHED SHEET)
DESCR. AA IBC /7t
CONTRACTOR
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
USE OF
BUILDING _ 7�U6i& 12-2
Class of work: POINEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
v o 4,,e
Valuation of work: $ /JQ/ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT L; NOTICE
BATHROOMS __ TOTAL SQ. FT. GARAGE L
ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORIES BASEMENT L; OR AIR CONDITIONING.
TOTAL SO. FT.j2_#0_ FIREPLACE ❑ DETACHED I
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 U S ONLY
ordinance requirements regulating the work for which
the per it is issued and all work done will be in
confor ance therewith. PERMANENT : . SHORELINES
SEASONAL I 1 FLOODPLAIN I
Firm E.D. NO. S.E.P.A. 1
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
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 �.
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be conformance therewith. MOTOR VEHICLE PERMIT
AP LICL
ACCEPTED BY PLANS CHECK BY APPROVED OR ISSUANCE
Ow Date BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS PERMITNO.
i o
n >
D OO
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 A"'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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
.ter
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1/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.
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NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) GNA URE OF OWNER(S) OR AU Th�O E R 5 NT TIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
6HELTON PRINTIN3