HomeMy WebLinkAboutBLD20760 Final Mobile Home - BLD Permit / Conditions - 8/18/1987 Shorelines: li/ /4 Plumbing:
Setback: Mechanical :
Special Interior:
Conditions: FINAL: ,el�/<'8 1
MobileHome:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 20760 No. Floors 1 Sq Ftg 840
Owner ORCUTT, Kirk R Tel 275-2480 Date 8-17-87
Address P 0 Box 1332 Belfair Zip
Contractor None
Address Zip
Legal Description Collins Lake Div 4 Lot 4
Direction to projec S1 a NE 71 Pinetree Lane Tahuva
Plumbing Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other
1981 14x60 2 bdrm
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED//
PERMIT NO.��
A E MAILADDRESS CITY&STATE ZIP PHONE
OWNER � 3� '� ✓�i,rC W A 9�S�tC �77 ��?�
DIRECTIONS
TO JOB SITE jr f 101,4` ZN 7A IVVA L-0& sU
PARCEL LEGAL / �
NUMBER DESCR. L�BT � �P/ (p i U n5 C
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING ---
/. A
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK iqV
-., I'ac c712 /
BEDROOMS 2 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 FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT �k� 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
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 OWN[ER-zA&IAwA±lzv DATE X BY DATE
FOR OFFICE USE ONLY
DE TMENT Y SPPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
�.
HEAL H ` PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED B �FOUA PERMIT VALIDATION //
BTOTAL 7 6 . 7,r ,
CASH CK MO
PLOT PLAN
ADDRESS /V. E 7/ gJ6_,`9 PERMIT NO. y o
COt,(.I I�15 �i��� •
� o
LEGAL
DESCRIPTION LOT
r BLK ADDITION
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 AND 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'
1
N
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
fiat obtaining approval.
NAME(!) OF OWNER(a) OF SITE i STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
IISTRICT AS NOTED DATE