HomeMy WebLinkAboutBLD2449 Final Mobile Home - BLD Permit / Conditions - 7/17/1978 Veach, Ronald L. #2449
6-21-78
Mission Creek Tracts Blk 5 Lot 1
End of Mission Creek Road
Mobile Home
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER N M ` MAIL ADDRESS CITY&STATE ZIP PHONE
h
DIRECTIONS
TO JOB SITE
LEGAL / (❑ SEE ATTACHED SHEET)
DESCR. 'la
N E MAI ADDRESS CITY&STATE LICENSE NQ. PHONE
CONTRACTOR tr
/
USE OF
BUILDING Ile v-e,
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE�Q
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT Li NOTICE
BATHROOMS_ GARAGE Ll
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIESBASEMENT [ ] ATTACHED L] OR AIR CONDITIONING.
TOTAL SQ. FT.4LIr FIREPLACE LL DETACHED L
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 SHORELINES J
SEASONAL I i FLOODPLAIN [
Firm
E.D. NO. S.E.P.A. I i
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 issued and that all work done will ROAD ACCESS
b conformance therewith. MOTOR VEHICLE PERMIT
APP IC TION ACCEPTED BY PLANS CHECK BY APPRO ED FOR ISSUANCE
OwnQr Date ��C^
P N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS J7 X 4- 1Y[j f' /SS%Q N �f L'C P PERMIT NO.
LEGAL
DESCRIPTION LOT f BLK ADDITION
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 P"'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.
."t'j /a-C ��e
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARrX 5' OR 1"=20'
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.
AMEl51 OF OWN ER(SI OF'SITE & STRUCTUREIS) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED /1' �� J ��� DATE
DISTRICT AS NOTED L�
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