HomeMy WebLinkAboutBLD28382 Final Mobile Strips - BLD Permit / Conditions - 8/28/1991 Shorelines: Plumbing:
Setback: Mechanica
Special Interior:
Conditions: FINAL:- xxwow -S' .3�Y' ' I
Mobile Hcme:
Smoke Detector: -a�_- oy
Remarks: GOv"'l`/ F�
ooting:�iK�as
Setback: Yoppe T
Foundation G;,#RAGaa cAk—T
Walls: . Me tiz F&-�
Framing: J �nt
Fireplace: '$
Wood Stove: -z
TYPE - - -i`10B1LE-STRIPS
No. Floors
S Ft
Permit No. 1 q g
28382 1 Date - -
Te ��
Owner 8 - 02 6 14
� nnNnT n_ wARn 71 9 8
Address i,755 Banner Rd Se Port Orchard Zip
Contractor Self
Address Zip
Legal Description Collins Lake div 2 tr 39
Direction to project site Go past Befair State Park to
Effendahl Pass Rd follow signs to Collins Lk go
Drive o and lake tq Pine tree P 1 Dry is 3rd on right
Plumbing Mec anica Sewer Wood Stove
Fireplace Deck mirage arport
Basement soft —ether
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME 1 MAILADDRESS CITY BSTATE ZIP PHONE
0c,P.� ►'Yl c Oe,naUA 4-755 IP ahhpe 0 Sr Poe-i- Oac�wec� IJA. oi8366 7 11 028
DIRECTIONS
TO JOB SITE Go Pasfi Ise 1p"6e- St Raa(c Ce P4z 2d, Fellow 51 nS —Ce
CoII,vts Lk. cio aleaLxv\ 4 Lk "Co P,v%f TetE PL. deiutw, �3 R'A It.-,
PARCEL �o o��e9°` LEGAL
NUMBER z2331 51 00039 DESCR. Cell ;hS LK 4 Z Tei.ct" 3-1
NAME MAILADDRESS CITY RSTATE LICENSE NO. ZIP PHONE
CONTRACTOR owns p
USE OF L
BUILDING �f5 C� �TiQ`
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
WORK DESCRIBE 5 or?c et ft 1C i L Gc.S 4— -ir c tLOK S Ovt Exi r+t-"\
✓ o6 i �-F k0mc P(�� ckbwA fapo e- be,-eki t e add 5kte_ (
C' 12.0v'iA_zk vtor"e,
BEDROOMS Z DECKS I CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. i GARAGE CONDITIONING.
NO.OF STORIES BASEMENT nC ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE VtO DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED.
PERMANENT SHORELINE KO
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
OBTAINING APPROVAL FROM THE
,/BUILDING
DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER W�1 YKc�A DATE " «" I I X BY __._.— DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVENo DEPARTMENT YES No
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT IE�
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANSCHECKB� AP ED!:: 1,;SS,,ANPE PERMITVALIDATION
TOTAL
� CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
ME AIL ADDRESS CITY&STATE ZIP PHONE
OWNER (, a.k� I'►)40nglA y755 Bav►► cK 4U S� Pt Olr cha?,d l.Ja. 9s— 87 1-17=8
DIRECTIONS
TO JOB SITE o Pay t 1361 F", 5'k O&F-W to tr Fsri ahl aSS AA Fe I(Oki i `t5 to
Col l i tl S LK_ �7 b q l2of.�ln d Lk. 'tJo f't r`>� tit. �L. aQivst ib► i s °d O vL h f
PARCEL LEGAL
NUMBER ObTfog DESCR. �COOINS la jC,= - 2 42 331 5I cce39
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building &septic system setback distances from all property lines& easements.
Indicate North
O Well and water line.
v
In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage.
O Attach copy of septic system"as built" or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
E - - --- _
bb &I E 'L
t
b
.9
f N
0
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.
Date► ry, Z C-0 , -a
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
NAr
1-4
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