HomeMy WebLinkAboutBLD18789 Final Mobile Home - BLD Permit / Conditions - 9/22/1987 TYPE MOBILE HOME
Permit No. 18789 No. Floors 1 Sq Ftg 500
Owner HOWELL, Jack Tel 275-4905 Date 6-13-86
Address NR 1660 Tahuva Dr. Tahuva Zip
Contractor _ RrPmerton Mobile Homes
Address Zip
Legal Description Collins Lake Div. 3, Lot 59
Direction to project site
F. 50 Mt. View Place
PlLmnbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1963 10x50 2 bdrm.
Shorelines: /1/,4 Plumbing:
Setback: Mechanic
Special Interior:
Conditions:
Mobile Home:
Swke Detect :
Foot Remarks:
Foot*
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
--------------------
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUEDu' /�' �
PERMIT NO.,
ME MAILADDRESS CITY&STATE ZIP PHONE
OWNER -
DIRECTIONS Ile ILDI
TO JOB SITE
LEGAL ,
DESCR. /
NAME MAIL DR SS CITY&STA LICENSE NO. ZIP PHONE
CONTRACTOR ����
USE OF 7
BUILDING
CLASSOF W ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ ...
DESCRIBE
WORK
BEDROOMS 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. FIREPLACE DETACHED ABANDONED FORA PERIODOF180 DAYS AT ANYTIME AFTER WORK ISCOMMENCED.
PERMANENT SHORELINE
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
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 :4 NER DATE X BY DATE
i FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION ) i
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 I PLANS CHECK BY AP ROV OR ISSUANCE PERMIT VALIDATION
CASH CK MO
TOTAL J,`�
PLOT PLAN
ADDRESS PERMIT NO. O o
f o
n >
a o
o
LEGAL
a
DESCRIPTION LOT �j �� BLK ADDITION
e 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 Pl"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-
TION THEREOF.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
i
r
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.
NAME(SI OF OWNER(S) OF SITE 6 STRUCTUREM (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
CHRISTMASTOWN PRINTING