HomeMy WebLinkAboutBLD94-0329 Expired Mobile Home - BLD Application - 7/22/1999 � 6 9 � �
" � LV MASON COUNTY Permit No.
MAR 16 1994 BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 �V� O�j�
PLEASE PRINT
#1 Owner Phone# 4 Z.G — 2 7 2 7
Site Address L% I� �' ��X��,r e n _� Fire District#
Cityf�fa� S", zip I Ir
Directions to Job Site 5/ Y a /`P• tt X lye 62
Owner Mailing Address
City St Zip
Lien/Title Holder ; _/ -i'o1je-t1it?
Addressva6. CQ��Tr-G �' :5��-✓ 21�Fblll csrl� J/lc'—
Clty( �,Ly StZipg`S�f��
#2 Contractor Name� Contractor Reg #
Address �S ���. Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well !-'
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No.32./. -a- qoi 2.V ,
Legal Description 5A't` O
NIX
#5 Building Square Footage: (existing/proposed)
1 st FI')" / 2nd FI / I Loft /
Basement / Deck / bedroo / #bathrooms /
Garage / Carport / Circle: ed or Det )
Other sq. ft. /
#6 Use of building 4 Describe work ; ��_ a
#7 Type of Job: New Add Jair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length &e'Ql Width t L! Serial No. 13 1GU
# Bedrooms_ # Bathrooms ( Type of Heat
Purchase Price $ /,5-0 G
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
fl
10c'le 4
i we j/
17 JL,
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
AP
' 1 E
seer aw°
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Plumbing Fixtures ($3$3 eachl Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE_ FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
of Water Htr Heatpumps
�LadRdry Washer Vent Systems
Sinks of Vent Fans
_Floor DraN . Boil /C m re sors
Laundry Basins HP
Dishwasher No. Air H n I a Units
_Disposal _ cfm#
Urinals No. Fire Protection vstems
Other Auto. Fire Alarm s 50�00
Fixed Fire Supp. S 50.00
Permit Basic Fee 1 ,00 Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ � her
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE „ f�o "� DATE
[FOR OFFICIAL USE ONLY: Accepted by: - Date:J,,, - ���
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: A CY-3
Environmental Health:
Building Plan Review
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Otfie r
Building Valuation: TOTAL FEE
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O. Box 186 Shelton,Washington 98584
(360)427-9670
BUILDING PARKS&RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
Date:
v
1� L'P rw1l Permit Number:. CAQ -c?-W-)
NOTICE OF PERMIT CANCELLATION
In reviewing our records we have found your application for a building permit in structural hold
pending receipt of information requested by this department. This permit application has been
on hold for more than 8 weeks. At this time we are attempting to clear all of our back logged
structural hold files.
If you intend to keep this permit process active we must receive the information requested within
ten working days from the date of this letter. Additionally, you will be billed for all review fees
that have occurred to date.
If you need any help regarding this matter or if you believe that you have received this notice
in error please call (360) 427-9670 at.
Sincerely,
Building Department uja'o , Ju w J
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