HomeMy WebLinkAboutBLD1800 Addition - BLD Permit / Conditions - 4/12/1977 1
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Lillehei , George #1800
5-2-75
Tahuya River Valley, Division #2, Lots 14 8 15
Addition of bedroom and porch to mobile home
and installation of mobile home
$1,680.00 (addition)
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BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
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PERMIT NO. 10'00
Applicant to complete numbered spaces only.
JOB ADDR ESS -'^
1 LESCR. /G) / /)/ ��u /•• /, Veil ���4 I[- jSEE ATTACHED SHEET)
OWNER i+ MAIL ADDRESS z" PHONE
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CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
s S& ,. • 77 S1S7 C /< z 3 ESN
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
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USE OF BUILDING
7 �ile_
S 8 Class of work: 8 NEw ❑ADDITION ❑ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work: � X O 7__
10 Change of use from
Change of use to
11 Valuation of work: $ //,-5-eC
aQ°��Zjryt PLAN CHECK FEE PERMIT FEE ,J 7,
SPECIAL CONDITIONS: Type of Occupancy
Const. Group Division
Size of Bldg. No.of Max.
(Total) Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY PLANS CHECKED BY AP ROVED.FOR ISSUANCE BY. Zone Zone Required ❑Yes ❑No
No.
o of OFFSTREET PARKING SPACES:
Dwelling Units Covered Uncovered
N 0 T I C E Special Approvals Required Received Not Required
ZONINC.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT. r
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Scecify)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
SIGN U OF CONTRACTORXORUT R ZE AGENT (DATE)
I
NATU F OWNER IF OWNER BUILDER DATE)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
( SHELTON PRINTING CO.
PLOT PLAN
ADDRESS ��X / lj�` �,4y u/ ✓ PERMIT NO.
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LEGAL { m
DESCRIPTION �' 7— LOT :2/ '�z
Ll BLK ADDITION N
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS_ s� , Ft.
INSTRUCTIONS TO APPLICANT 7133
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILD;NG 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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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) OF OWNERS) OF SITE & STRUCTURE(S) (PRINT) SI ATU OF OWNER( OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED 0 —
DISTRICT AS NOTED NIE.[�C.Q �Lt�-> ,' �� DATE