HomeMy WebLinkAboutBLD9548 Mobile Home - BLD Permit / Conditions - 11/8/1979 r�
4ace, Virgil R. #954`8
11-8-79
Tr. 45 Store & Peste 11-23-2
2 mile from Baar Creek Rd. on Elfendhl Pass Rd.
Mobile Home
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS ^ n t
TO JOB SITE -2 In
LEGAL C �� —�— (❑SEE ATTACHED SHEET)
DESCR. T!l' C STG'i• PS /G— J�Cf. �� /cr7f�i
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR fe/ir
USE OF J
BUILDING u �/
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
, .
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS_. _ DECKS _ CARPORT [ I NOTICE
BATHROOMS_ TOTAL SQ. FT.--- GARAGEI
ATTACHED 11 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT I SHORELINES ❑
SEASONAL [] FLOODPLAIN ❑
Firm E.D. NO. __ _ S.E.P.A. ❑
By Special Approvals IN OUT
YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. d0
PUBLIC WORKS
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 in c formance therewith. MOTOR VEHICLE PERMIT
/ A ICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner J ate . BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
/ ez AAA c
ADDRESS PERMIT NO. o
n >
a oo
LEGAL
DESCRIPTION x?'r'y7LVF 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"ID 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'
I
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.
-, ,
N AME(S) OF OWN ER(S) OF SITE 6 STRUCTURE(5) (PRINT) NATLL, F OWNER(S) OR AUTHO IZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
-14.1-ON PRINTING
MASON REGIONAL PLANNING COUNCIL
5th and Bireri Stteets
P. 0. Box 186
Shelton, Washington 98584
Phone 426-5593
MESSAGE DATE 11 / 6 / 7 9 REPLY DATE
TO
Virgil R. Nace
Star Route 2, Box 121
Belfair, Washington 98528 AJL cvvi k /
Mr. Nace•
f
I received your building permit application h
for a mohile home today. T will need other JAA-
mation. The size, year model of unit. How many mul LA�
bedrooms. Is this already on the property? If not 0, s
_�..
we do need the road permit from Mason County. �
r
Please notify me of this information and the
mobile home dealer delivering the mobile berme as
coon ac nncgihle and T will Se11d permitl.
,\
SIGNED L� SIGNED L U v
4S 473 SEND PARTS 1 AND 3 WITH CARBON INTACT- PART 3 WILL BE RETURNED WITH REPLY.
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