HomeMy WebLinkAboutBLD96-00184 Mobile Home - BLD Application - 2/27/1996 ,�Vt °fie !S n0�a'MVLING
) h ar GZ
��.K Permit No.
,,,*1 ny ire s � p`�''�' MASON COUNTY
a5 5G�w"� - - /Q" PERMIT APPLICATION
at�tG�hP�06U/Z�' 4W �aV
Box186, he 7-96{70/1(-800-562-5628
� u (
42
rlo or/ ;v ' ,H�e(
PLEASEPRINT / -nd4Vi
#1 r In,'ellkkpi
_Phone# V6" 7 _
i e Add ess :, tl ` _ Fire District# S
ity L� v' �/� St Zip
Directions to Job Sit
Owner Mailing Address ,
City St /�' Zip
Lien/Title Holder
Address
Clty - St Zip
#2 Contractor Name -9.D i4 MU ih Cw-w C s Contractor Reg#A O tV►OC- O�y
Address 2V,'RD5 .. ( -6- Expiration Dates
City S St zip Phone#si D6-9 Y7- 7 VSiS
#3 If septic is located on project site, include records.
Connect to Septic? .- Public Water Supply Well
Connect to Sewer System?_Z�Name of System
(If residential, proof of potable water is required)
#4 c el No. a�(� - �� - "d� 4FALTH SERVICES
Zegal Descriptio `o1 D
x a-
4114� rri I-1O £ A-U- V A-e-- A&hk/n
t� o e � � ��s � �J `
#5 BuildiN �dobo g
1s WINI 2nd FI / 3rd FI / Loft /
Basement / Deck,2-��-/ Wf —#bedrooms / #bathrooms/
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Use of building �� � j
0� Describe work
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year J97& Make Model Ki--23980 2
Length YS Width ZS Serial No. �?W
#Bedrooms-3#Bathrooms o2 Type of Heat 6FA5e-TiPi C _
Purchase Price$ 9-713/7, q 3
#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 Indicate Directional b N, S, E, W)
Name of Flanking Street in relation t y of plan
Name of Fronting Street p
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 eachj Egg Mechanical Fixtures ($6 eachj
No. _Toilets CIRCLE FUEL TYPE: Gas, Electric,
y ath Basins Heatpump, Other
_B h Tubs No. _Uak Fees
_Sho ers Furn BTU
_Hot W er Htr VIr
_Laundry asher
_Sinks jNo.
Floor Drains rLaundry Basins HP
Dishwasher
_Disposal _ cfm#
_Urinals Ng, Fire Pr
'ion Systems
_Other _ Auto. Fire arm Sys 50.00
Fixed Fire S p. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink ys 25.00
TOTAL PLUMBING $ No.. Other
Gas Outlets
Wood, Gas, Pellet Stov
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 TOTAL MECHANICAL $
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 OFTHE 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. DEPARTME T
X OWNER X BY . cl,! JY
DATE DATE
I tf fFFIQt�°L I. S tiLY Accepted 6�y ! Otte
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review dad
L/111 f
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit �i �
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other f:� N
Other
Building Valuation: TOTAL FEE