HomeMy WebLinkAboutBLD13747 Final Mobile Home - BLD Permit / Conditions - 4/5/1983 Crosswhite, Thomas #13747
275-3339 3/22/83
E 1/2 of SW 1/4 & 1/2 of SE 1/4, 29-23-2
Ranch Drive - Tahuya/ North Shore Road about 5 miles,
turn right on Haven Lake Rd, go straight for 4 miles
passing Tahuya River & Collins Lake turn-off, 1/2
mile past Collins Lake turns, turn on wide dirt road
on right, go to Lot 2, left side, fence in front.
Mobile Home(14'x70' , 1981) Contractor
None Listed
$17,094.00
1
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechapical:
Roof:
Exterior:
Interior:
Final: d 4- S S
Stop Work:
Mobile Home:
Smoke Detector:
Remarks:
I
s BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED h
PERMIT NO. g-3
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
SSwIti. S Ol f U,w �SSZ�s �L�S 333
DIRECTIONS Lc'�
TO JOB SITE
LEGAL �� (❑ SEE ATTACHED SHEET)
DESCR. �� �` l Un Zq l own 0)L 3 64'k _kar Lv. m. /1A._'1(14
AME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE 7
CONTRACTOR r y LL)y ya SE— y a q- 3 �.
USE OF r
BUILDING FA W_
Class of work: ❑ NEW ❑ ADDITION ❑ AL RATION ❑ REPAIR MOVE ❑ REMOVE
�O r
Describe work:
9,F )CDC) (Yl odu l at, mob,L u—, 4ome., - us,.d .
Valuation of work: $ 17,094.00 PLAN CHECK FEE PERMIT FEE $64.25
SPECIAL CONDITIONS:
BEDROOMS ��i M DECKS _ CARPORT C NOTICE
BATHROOMS TOTAL SO. FT. GARAGE L!
ATTACHED i' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L; OR AIR CONDITIONING.
TOTAL SO. FT.924 FIREPLACE r DETACHED 1�
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 ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State ofWashington and I aware of the FO O F F I C E USE ONLY
ordinance requirements
the regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT V SHORELINES ;
SEASONAL[! FLOODPLAIN i 7
Firm E.D. NO. S.E.P.A. i
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
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 ACCESSIf
be ance therewith MOTOR VEHICLE PERMIT
Owner —� 11 APPLICATION ACCEPTED BY PLA S C CK BY APPROVED FOR ISSUANCE
ate . 'i� BY /s
P N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
r"
ADDRESS _Tc�YllA i�0� PERMIT NO. f o
a
LEGAL
DESCRIPTION LOT BILK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. Q
INSTRUCTIONS TO APPLICANT
V
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 r
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. f
P
Z
INDICATE NORTH IN CIRCT GRAPH SQUARES ARE 5' X 5' OR 1"=20'
C> :
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1/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.
NAMES) OF OWN ER(31 O SITE d STRUCTURE(5) (PRINT) SIGNATURE OF OWNER(S1 OR AU' ORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE I
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING