HomeMy WebLinkAboutBLD4295 Final Mobile Home - BLD Permit / Conditions - 6/2/1979f
Weatherwax, Robert L. #4295
4-26-79
Lot 9 Blk 6 Mission Creek
Belfair State Park take right up Mission Creek rd
to Steelhead Drive �XXXXXXVCXKMXXXXXX
Mobile Home
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 �/ q
DATE ISSUED
E T N O.
OWNER NAME t MAIL ADDRESS CITY 9 STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE �� /2 ST tynl� T/3kt v Srio.✓ctPQ1L� D S'' p, ve ,
LEGAL / (❑ SEE ATTACHED SHEET)
DESCR. ��L� / S/o�/ C�'2y°!` D V o/2Allop e 9,9
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CONTRACTOR
NAME , MAIL ADDRESS CITY&STATE LI SE NO. PHONE
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USE OF GJ
BUILDING 'Pps�/���Ge_
Class of work: X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: / _
Valuation of work: $ �9�/ PLAN CHECK FEE PERMIT FEE
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SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
b O formance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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
Ownef Date WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
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ADDRESS 7 �IL `
d /eT L" /c c t7 G Q 7f-3 c C. PERMIT NO. °
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LEGAL rN/�ss/0�
DESCRIPTION C LOT BLK �j ADDITION N
SITE AREA 177 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS ZY 40 Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO S(,e,LE 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.
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.
B"'el"'er
NAMES) OF OWNER(S) OF SITL & STRUCTURE( ) (PRINT) SIGf ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
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