HomeMy WebLinkAboutBLD21847 Final Mobile Home - BLD Permit / Conditions - 5/17/1988 1
TYPE MOBILE HOME
permit ND. 21847 No. Floors Sq Ftg 1056
Owner BUCK LAKE CAMPGROUNDS Tel 426-3954 Date 4-21-88
Address E 641 Phillips Lk Lp Rd Shelton Zip
Contractor None
Address Zip
Legal Description NE,SE, 5-20-2
Direction to project site To Pickering Pass Rd.To Phillips
Lk Rd, to E Phillips Lk Lp Rd. approx 1 mi. to
Buck Lake Campgrounds
P ing Mechanical ter Woo Stove
Fireplace Deck Garage Carport
Basement loft Other
1982 24x44 2 bdrm
Shorelines: Plunbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile ane:
Smoke Detector:
Remarks:
o ing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
i
Wood Stove:
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.c;�?J ,7
OWNER AME MAILADDRESS p:zy/ I0,qr�L &STATE ZIP PHONE
C R kF CR,WGRDu N17 4 6-5 �14NF_ OD 59F-LtV 1) WO gs 41 3 S
DIRECTIONS
TO JOB SITE W -r- - .0 fft4 - Li-pn/ 76 P'!c lreR .0 ! �fySsAG T r L4 1PS
J-19('ti /?,04 14 - N HL '"PS I-RILL- IkAoP l IJ6 /V( f O 4c ,4,4)rL� C,4.-IP6r'owi
PARCEL LEGAL
N U M B E `'�cc - Y/- cccoo DESCR
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR A
USE OF
BUILDING
WORK CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK 'IFP) /iCF 1 .✓ s /koTdr F 14o - wIr ti0 HF /�f.v>�.
v a.
�EDROOMS-_ DECKS A(2 CARPORT zvi4 NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS I "'. TOTAL SQ.FT.)ds& GARAGE IVA _ CONDITIONING.
NO.OF STORIES 1 BASEMENT A 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
:TOTALSQ.FT. FIREPLACE �� DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTERWORK IS COMMENCED.
PERMANENT SHORELINE !N/a
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI IN A VA FI, ROM T E ILDING D PARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
n'XZ�7� X BY DATE
FOR OFFICE USE ONLY
DEPAkAIMENT Y SPPROVEDNO DEPARTMENT VESPPROVENO BUILDING VALUATION
HEALT J PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
vC SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICAT N ACCEPTED BY PLANS
/CH CK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
Cc'I L�. �, BY 'L�
CASH CK MO
6� 76
PLOT PLAN
ADDRESS b 7 / /I/ �O f �I►IC� �OO� PERMIT NO,
� o
LEGAL
DESCRIPTION LOT BLK ADDITION
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"a20' 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 POW
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
/ D
01
x y
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.
z?&ick 1%,%7f --C Ca&I IQ e Af,�
NAME(S) OF OWNER(S) OF SITE a STRUC TIP
REl (PRINT) IGNATURE OF OWNERS) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE