HomeMy WebLinkAboutBLD9922 Mobile Home - BLD Permit / Conditions - 6/29/1982 Trevino, Roy V. #9922
No Phone Listed 6/29/82
E i/2, SW 1/4, W 1/2, SW 1/4, 29-23-2
Ne 501 Ranch Drive, Tahuya
Mobile Home Contractor;
Chaco of Wa
$16,340.00
- 6006
Shorelines:
Setback: p 1<
Special.Conditions:
Footing: - a7/ 7,25
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final:
Stop Work:
Mobile Home:
Remarks:
• BUILDING PERMIT APPLICATION
>r
• MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 $ 7_
DATE ISSUED
PERMIT NO. / '/ 17 �-
OWNER v AME MAIL ADDRESS CI &S TE r' 21P PHONE
DIRECTIONS
'l
TO JOB SITE
LEGAL (� T (ElSEE ATTACHED SHEET)
DESCR. r sUJL S1 +ZtC o� f /�, a�.3/� 1— 4/
CONTRACTOR
E AIL ADDRE S CITY S STATE LICENSE NO. PHONE
�
USE OFIf
BUILDING A .
Class of work: KNEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $Ot PLAN CHECK FEE PERM FEE S_
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT [] NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE L]
ATTACHED C] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE G DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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 FO OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
Conformance therewith. PERMANENT V SHORELINES I 1
SEASONAL I i FLOODPLAIN L1
Firm E.D. NO. S.E.P.A. II
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
`rl Io
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 BUILDING DEPT. 2
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance thwith. MOTOR VEHICLE PERMIT
111
� APPLICATION ACCEPTED BY PL HECK BY APPROVED F SSUANCE
�
AN
Own �-�''C9�te- /�,,!,��� BSA/
PL N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS • PERMIT NO. o
i v
n >
a o
LEGAL
DESCRIPTION LOT 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"'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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 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.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED DATE
DISTRICT AS NOTED
1 6H ELTON PRIN TINS I