HomeMy WebLinkAboutBLD19031 Final Mobile Home - BLD Permit / Conditions - 9/4/1986fTYPE MOBILE HOME
Per it No. 19031 No. Floors Sq Ftg 972
Owner HOOD. Donald A. Tel 275-3695 Date 7-24-86
Address NE 130 Pine Tree Pl, Tahuya Zip
Contractor _None
Address _ Zip
legal Description Collins Lake div. 2, Lot 38
Direction to project site Lot at end of cul-de-sac on
right side.
Plumbing Mechanical Mbchanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1986 27x36 2 bdrm.
Shorelines: N f Plumbing:
Setback: Mechanic
Special Interior: 1-7
Conditions: FINAL: e''
Mobile Home:
Smoke Detect
Remarks
Footing
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 y
426-5593 DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
�r.1A�D 4-6flD ►) 110 1061 Tazc F4. T AtA uy 4 , w�1. Qg�Bg Zo6-Z7s 3v9s
DIRECTIONS
TO JOB SITE LO i /1r- {JD ( -a.cL L' c' S/Lc— cn> _U7 S L0�.
LEGAL
DESCR. P1� Z LoT 8 �'OL(-L/JS AKc
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING 12cS1 cuC.c
CLASS OF NEW ✓ ADDITION TERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK S8T U
BEDROOMS Z 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. 3 FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT V SHORELINE
SEASONAL
OWNERS�FFIDAVIT 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
REGISTR ION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS 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 CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X NER—T43elA ==)ATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY A CV R ISSUANCE PERMIT VALIDATION
TOTAL y�'
.�� _ CASH CK
PLOT PLAN
ADDRESS K-),' L= �� �I �c TYLt'C 1" L TA �9 d , PERMIT NO. F a
C,o LI_Lk s L etc-
D O
LEGAL
DESCRIPTION D t L 2 LOT 3 BLK ADDITION u
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"=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 ARID 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.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
Z�
S �
� r
• o.J
0
LAA
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.
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) .4IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
GHELTON PR;NTIN