HomeMy WebLinkAboutBLD24543 Mobile Home - BLD Permit / Conditions - 10/5/1989 19 60 (v ( 0
Shorelines: Plumbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
MobileHome:
Smoke Detector:
Remarks:
Doting:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HONE
Permit No. 24543 No. Floors Sq Ftg 720
Owner DIXON, Richard Tel Date 10-5-89
Address NE 1460 Blacksmith Dr Tahuya Zip
Contractor None
Address Zip
Legal Description 10-23-2 Tr 61 Survey 11117
Direction to project site To Bear Creek-DeWatto Rd, stay
on till Blacksmith Lake Rd about 1 -112 miles.
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck arage 7Uarport
Basement Loft Other
1967 12x60 3 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
�U 79 006 /v' PERMIT NO.
OWNER NAME ILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS � on 4 ,
TO JOB SITE (,90 -t-1,
PARCEL t'_S�• LEGAL
NUMBER (/ Dl1�.5 M DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSrNO. ZIP PHONE
CONTRACTOR DlJF Q/ D /� 7
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
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
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASON L
I
SAFFIDAVIT CONTRACTORS AFFIDAVIT
THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
TION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
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
ORMANpCEE�T�HEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
GAPPRQYALFR�HE BUI4DING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
R C�AAZW DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. u BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP 3 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY I PLANS CH GGY APP,R�O�FORANCE PERMIT VALIDATION+� BYD� CASH CK MO TOTAL C/�J
PLOT PLAN
ADDRESS PERMIT NO. s o
•
� o
LEGAL
DESCRIPTION LOT BLK ADDITION
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 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
W
2
0
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) O OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SiGNATURE OF OWNER($) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE