HomeMy WebLinkAboutBLD9235 Final Mobile Home - BLD Permit / Conditions - 11/26/1979 Hammrick, Harlan 0235
10-25-79
Mission Creek, Lot 5, Block 2
Turn right at Belfair State Park 1.7 miles
Mobile Home
• BUILDING•PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED A0
PERMIT NO.
OWNER NAM MAIL AD ESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE �(,y
LEGAL (❑ SEE ATTACHED SHEET) � Ile
DESCR.
aME. AIL ADDRE CITY&ST T LICENSE NO. PHONECONTRACTOR 15
d7l�4 - J
USE OF 190,
BUILDING �D �o� /O D T, S " 04 C ree&
Class of work: N W ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Des fribe work:
9- -C11- 00 60
FEE
PLAN CHECK FEE PERMIT F .
Valuation of work: $ i
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOM TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT FIREPLACE I I 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 1 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 SHORELINES I ;
SEASONAL [ FLOODPLAIN I_;
Firm E.D. NO. S.E.P.A. 11
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I 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 issue,P and that all work done will ROAD ACCESS
b in conformanc��aate .9-11-
MOTOR VEHICLE PERMI0 e 72- APPLICATION ACCEPTED BY PLANS CHECK BY APPROVEp FOR I�NCE
dy
7
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS /�/�( !( � L�r� PERMIT NO. 4JJ f o
r-r i o
n >
v
v
LEGAL �y
/K �
DESCRIPTION LOT Jr' BBILK :� ADDITION o
rrc as Ve-0or ;'n Uc}l.
SITE AREA n 5
D 6 ' �
Sq.Ft. AREA OF SITE OCCUPIED BY BUILDINGf�ty _ �1) 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.
�x INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
V
Kv
0
� R
0 1n
I y that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without y�
first obtaining approval.
NAME(S) OF OWNER(3) OF SITE & STRUCTUREl3) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING