HomeMy WebLinkAboutBLD0219 Final Mobile Home - BLD Permit / Conditions - 10/4/1984 ROBERSON, Harold #0219
` 9-18-84
Parcel 3 19-23-2
NE 2870 Haven Way
Tahuya, Wash 98588
Corner of Haven Way & Mt. View Drive
I
Contractor
Chaco Homes
Mobile Home 14x60 2 bdrm.
$15,540.00
Shorelines: V A,
Setback: C+ i
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final:
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED ele C/
PERMIT NO.
)WNER ,_ AME MAIL ADW CITY&STATE I� PHONE
1XvW y1h U 02 be Sv /YC o`�� d veV tz
DIRECTION
TO JOB SITE
LEGAL 1IY— ? 39
SEE.=ATTAC DDESCR. _r 1'0 F
NAME MAIL ADDRESS PITY /TA.TE- / LICENSE NO. PHONE
CONTRACTOR w
USE OF
BUILDIN
Class of work: ❑ NEW ❑ AD ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Ga
Valuation of work: $ v p PLAN CHECK FEE PERMIT FEE
5— a. �4
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT Ci NOTICE
BATHROOMS__ _ TOTAL SO. FT. GARAGE []
ATTACHED L1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT.T1(/ FIREPLACE 17 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 FORA PERIOD OF 180 DAYS AT ANYTIME 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 USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
CO formance therewith. PERMANENT :! SHORELINES N 9
SEASONAL [ FLOODPLAIN
Firm
E.D. NO. S.E.P.A. I ,
By Special Approvals IN OUT YES APPROVED NO
Li o. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that 1 am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for X
which this permit is issued and that all work done will ROAD ACCESS
b in conformance therewith. / MOTOR VEHICLE PERMIT
/S APPLICATION ACCEPTED BY PLAN CK BY APPROVED R ISSUANCE
Owner � Date � B
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS U Vv PERMITNO. f o�
a v
v
LEGAL
DESCRIPTION / / LOT BILK 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'
T
I/We certify that the proposed construction will conform to the dimensidfns and uses shown above and that no changes will be made without
first obtaining approval. C>
IA k�al��rsa�
NAMES) OF OWNER(S) OF SITE S STRUCTURE(S) (PRINT) SIGNATURE O NE (SI O T ZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LI
APPROVED
DISTRICT AS NOTED DATE
GHELTON PRINTING