HomeMy WebLinkAboutBLD11566 Mobile Home - BLD Permit / Conditions - 10/13/1981 Wray, Lester C. #11566
10/13/81
Lot 68, Division #3 of Collins Lake
Collins Lake, left on Mountain View, follow to end,
sign with WRAY over drive, St. Rt. 2, Box 1112,
Tahuya.
Rebile Home Contractor;
Self
$4,725.00
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls :
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior:
Interior:
Final:
Stop Work:
Mobile Home
Remarks:
BUILDING PERMIT APPLICATION
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MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 /
DATE ISSUED /, � 3/
PERMIT NO.
NAME MAIL ADDRESS CITY 8 STATE _ZIP PHONE
OWNER L�.s►�'�.� . Wr *kt. 1. e II ^C_k c. QC. C,C)
DIRECTIONS I j I TO JOB SITE ..,Ilini Lars,— Le-it c•^ U;tt,/ fcjlco, fe- ;t 1A1ft 01Jc1 ciri)
LEGAL / ty c L (❑ S ATTACHED SHEET)
DESCR. LAt 06 ��V No• OT co/ -n �r`>:.
CONTRACTOR NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
USE OF
i
BUILDING TeC C)aK
Class of work: 8K NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
15 S E2uY- Qrq v.cw cvb;l
GvY i t c,• -re-
Valuation of work: $ PLAN CHECK FEE PERMIT F E
SPECIAL CONDITIONS:
BEDROOMS «. DECKS CARPORT ❑ NOTICE
BATHROOMS_ TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
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 FO 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 l, FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date ./0
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PLOT PLAN
ADDRESS 1 I�_r J r Z T< I�.. �C.7� w4_ �,, �. I�7RMITNO.
LEGAL *� C_0L .It%J �_AK ' ;�°
DESCRIPTION LOT JILT BLK ADDITION
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t �
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. `+
INSTRUCTIONS TO APPLICANT
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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 P"ID 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.B' X�V OR 1"=W
1
1. - a l� C x I k t'
S S F
IF I T I ' K2
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.
L ?,�> e.r- L- �r.-Y t- r,
NAME(S) OF OWNER(S) OF SITE h STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR A ORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTING