HomeMy WebLinkAboutBLD0217 Mobile Home - BLD Permit / Conditions - 12/5/1989 Shorelines: Plunbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
"TYPE MOBILE HOME
Permit No. 0217 No. Floors Sq Ftg 1080
Owner HOLT, James H Tel 275-2467 Date12-5-89
Address P 0 Box 727 Belfair Zip
Contractor None
Address Zip
Legal Description Haven Lake Lot 240
Direction to project site To Haven Lake, turn left at
Haven Lake sign & go 1 mile. On left.
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1987 27x40 3 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS CITY BSTATE ZIP PHONE
OWNER `- S 4 11cL .O{ -L FAI /f OhIlL
DIRECTIONS
TO JOB SITE rjI r. - - -/) i 6 AWc ,
f��3 �O Dom o
PARCEL LEGAL
NUMBER DESCR. '
AME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT/&ZD- FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY T T I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATI LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREME TS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN IN MANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
O8TA PAPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
JX W fl DATE X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED
DEPARTMENT YES NO DEPARTMENT YES No BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING IFIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS BY APPROVEA FOR ISfOANCE PERMIT VALIDATION
TOTAL
.L BY2�?L l
CASH CK MO
PLOT PLAN
ADDRESS f1 Lq&!:L4ZL —13jAC_1<y /' -# X�ERMITNO. 4 0
LEGAL 5_FC/3a 'TWP13.3N #?aLA) W 10- 7/eh_e_7-a 0 HAP i JF i'_I kE" ' °o
DESCRIPTION k$f $trlf AQ64116N
Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS *0 0 Sq. Ft.SITE AREA ;� � � � �
INSTRUCTIONS TO APPLICANT lq�
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 AND 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. i
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
S
r
LI
s
I/We certify that the proposed construction will conform to the d mensidns and u shbwn above and that no changes will be made without
first obtaining approval. /vo
j /O /
NAME(a) OF OWNER(al OF SITE a STRUCTURE(S) (PRINT) I IZ D R ATURE OF O N R(S1 OR AUTHOR ESENT TIV
DO NOT WRITE BEL( THIS LINE
APPROVED
DISTRICT AS NOTED DATE