HomeMy WebLinkAboutCOM2000-00085 Final Change of Use M1 to B2 - COM Permit / Conditions - 10/18/2000 CC44CRETE MECHANICAL MOBILE HOME
Fod';;igs-,,tback date by Ribbons
I� d s 'I[, by Gas Piping date b
!-aundation Wallsdate 0 date b Set Up
BG/SLAB Insulation by INSULATION date by
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date NG by date by date by
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PLEASE PRESS HARDL/ PERMIT NO.: l3tD
MASON COUNTY
BUILDING PERMIT APPLICATION
PERMIT ASSISTANCE CE"�Tf p 426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shel on 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner DOM CAO'r / CALQY 'rAMILY ZN�MtTAAIIP Contractor Name
Mailing Address LZ Mailing Address
�fy?7KLnitl� State/ _ Zip Code S5Z City State Zip Code
Phone(3(.o )2)'5.2a6'W Other Ph.( Ph.( Other Ph.(
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. , 'j q Iq I / OD11 0Fire District
Legal Description
Site Address(Please include street name, street number and city) 0 T ZZL:r I1 L, WN
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water (Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work Vp, -I "n-2 4bD WAILS
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit ?(Yes/No)
Installer Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements r which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conforman erewith. No changes shall be ma a without first obtaining shall be done in conformance therewith. No changes shall be made without
approva first obtaining approval.
X Date ' — X Date
OR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
........._ ......... .... _... _ ..._ __ _ _ _ ....__ .._..
DEPAKTA ENTA1 REVIEW APPROVED DENIED: C0NDI..10N CODES............. ............Building Department
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES