HomeMy WebLinkAboutBLD12233 Final Mobile Home Replacement - BLD Permit / Conditions - 5/19/1982 Swanson, Harrill M. #1G233
(275-6621) 4/5/82
Fairview Estates (Collins Lake) , Division 4, Tract 5.
North side Collins Lake, Pine Tree Lane, West side,
250 yards from Collins Lake Drive, Rt. 2, Box 1202,
Tahuya.
Mobile Home (Replacement) Contractor;
12'x50' , 1982 None
$11,100.00
Shorelines:____,]
Setback:
Special Conditions:r
Footing:
Setback:
Foundation Walls:_
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:_
Roof: _
Exterior:_
Interior:
Final:_,�1-� i90�� r
Stop Work: -�-
Mobile Home
Remarks:
1
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 _
DATEISSUED �� ?,,2,
NC, I V l �IAt TV,0 c �v'_ PERMIT NO. Za C2 3 3
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
IJAIZ1 t�/9 N . '� v 20 Z It v f9 . 9a Z75-66z.�
DIRECTION 6UeS'>' ;14C_ 1 /
TO JOB SITE 0(21 r1 c �c, / u3 �,/� �I@T Ce Aj 2$'� cS (2-t ZO1I rMS l-4Pc Q /VC
LEGAL 1 (❑ SEE ATTACHED SHEET)
DESCR. '01 R view FgtAres ccm I,)N3 LA 1�,6 Te", 140 Aj
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR D M �_
USE OF t
BUILDING es-I d PN
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: �)
i�S r ly 602
Valuation of work: $ /l 0 0. 0 D c�PLAN CHECK FEE PERMIT FED
SPECIAL CONDITIONS:
BEDROOMS_ {DECKS CARPORT ❑ NOTICE
BATHROOMS I TOTAL SQ. FT. GARAGE
ATTACHED L' SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT.A6ab 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 F O 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 1
SEASONAL ❑ 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 EALTH DE P #�
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be ip confo erewith. MOTOR VEHICLE PERMIT
S A DRY' �JF1 PLICATION ACCEPTED BY PLANS CHECK BY APPROVE FOR ISSUANCE
owner _ Date . 1 f/ Y
CHECK VALIDATION CK. M.O. CASH VERMIT VALIDATION CK M.O. CASH
PLOT PLAN
ADDRESS �O( I /Il'S �/��te PERMIT NO o
f o
= a
n f
LEGAL [� a
DESCRIPTION LOT 5� 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 A"'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. rr
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
L-. N
�J
(Z XS wt tbl c c,cK 35
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.
A ,;L111
NAME(S) OF OWNER(S) OF SITE 6 STRUCTURE(S) (PRINT) SI A URE OWNER(5) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELO THIS LINE
APPROVED
(STRICT AS NOTED DATE
6HELTON VIWTNT N'�