HomeMy WebLinkAboutBLD0531 Mobile Home - BLD Permit / Conditions - 5/19/1987 Shorelines: Plumbing:
Setback: Mechanica
Special Interior:
Conditions: FINAL:
Mobile ome:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove: `r ,Yi1i'�G✓�u QY
TYPE MOBILE HOME
Permit No. 0531 No. Floors 1 Sq Ftg 720
Owner BURGS F—r an7 Tel Date 5-19-87
Address NE 643 Blacksmith Dr Bremerton Zip
Contractor Self Lip
Address
Legal Description Blacksmith Lake Lot 45
Direction to project site Old Be air Hwy to Bear Cr.De-
watto Rd. 8 miles to Blacksmith Dr. 1.4 miles on
Blacksmith Dr to Lot 45 on left
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck arage -7-arport
Basement —Loft —Other
1968 12x60 2 bdrm
aa3i� - �8 - 004�0
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
aa3 Q dr ,S 6PERMITN0.
OWNER NAME MAILADDRESS a CITY SSTATE 9 ZIP ' rL PHONE
7-17
DIRECTIONS ��llll
TO JOB SITE ' Zezej, 7
IV
I_ -y
PARCEL LEGAL Q
NUMBER DESCR. GY, �� 8%�� �-h' �d /
NA MAIL ADDRESS CITY 8 STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING -
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT G NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. - GARAGE O CONDITIONING.
NO.OF STORI ES 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 SQ.FT. h° FIREPLACE_ DETACHED ABANDONED FOR A PERIOD OF180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED.
PERMANENT SHORELINE _
SEASONAL
OWNERS AFFIDAVIT 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
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OW E E ���� t7,� X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED Q=
DEPARTMENT YES NO DEPARTMENT YES NO BUILDING VALUATION
HEALTH CI PUBLIC WORKS FEE
PLANNING C FIRE BUILDING PERMIT
D.O.T. BUILDING z "i PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
I WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
'PLICATION ACCEPTED BY PLANS CHEFK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
yl/�/ TOTAL
BY /sYC CASH CK MO � �.J•
PLOT PLAN
ADDRESS PERMIT NO. 4 0
:
o
LEGAL A
DESCRIPTION LOT 'S�rs' BLK ADDITION
SITE AREA ,'��D" /O'D ` 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' `
ell
I�
c:y '
a
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a
I/We certify that the proposed construction will conform to the dirmnsions and uses shown above and that no changes will be made without
first obtaining approval.
NA (S) OF OWNER(s)A5F SITE & STR TURE(S) (-PRINT) IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO OT WRITE BELOW THIS LINE
APPROVED �y
DISTRICT AS NOTED DATE
1