HomeMy WebLinkAboutBLD14410 Mobile Home - BLD Application - 7/20/1983 BUILDING PERMIT APPLICATION
+ MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 Q_ 3
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
Fred Barrett N.E. W Vista Pl. Tahu a Wa. 275-3223
TO JOB SITE From Belfair, North Shore Rd. to$ Belfair St. Pk. % mile right to Haven Lake
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. TRACT 372 HAVEN LK.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING Residence
Class of work: KKNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Move double wide mobile home onto lot.
Valuation of work: $ IFV u I(o, 0150 0 D PLAN CHECK FEE PERMIT FED as
IV . �t
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SO. FT.�_ 3 GARAGE [I
ATTACHED L: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. FT. 1300 FIREPLACE L l DETACHED C 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 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
SEASONAL F FLOODPLAIN L:.
Firm E.D. N0. S.E.P.A. C
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is Issued and that all work done will ROAD ACCESS
be in conformance therewith. MO R VEHICLE PERMIT
�� A P ICATION ACCE TED BY PLANS CHECK BY APPROVED OR ISSUANCE'
Owner Date . B
h
P CHECK VALIDATION CK. M.O. CASH PERN4t VALIDATION K. M.O. CASH
PLOT PLAN
ADDRESS E 9 40 Vista Pl. a \ VIIAAi PERMITNO. 0 o
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LEGAL
DESCRIPTION LOT BLK ADDITION N u
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SITE AREA 7D Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS_ Sq.Ft. W
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INSTRUCTIONS TO APPLICANT (D
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE rt
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) 't
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FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF Z
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION Al"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- i vl
TION THEREOF.
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INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' d
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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.
FRED BARRETT
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING