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HomeMy WebLinkAboutBLD93-1302 Cancelled Modular Home - BLD Application - 7/22/1994 Permit No. MASON COVNW BUILDING PEiTW'T APPLICATION 9y � a 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-967011-800-562-5628 1� ?7740 PLEASE PRINT #1 Owner �/rJXJ !��?QT�?iL Phone# ,Z 33 Site Address '7�02 �'PfJ�Fz'GcJ Fire District# CityTip9s��4/ Directions to Job Site !� Owner Mailing Address vA6 (OCo City St-- zp Lien/Title Holder 'aA afzove- Address City St Zip #2 Contractor Name y*0'0 rK)S - Iclj, Contractor Reg# Address 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 S stem? Name of System (If residential,proof of potable water is required) #4 Parcel No. Legal Description . 611 Gd= -� o �z d y' U �r�- ; SX4 2y,TI !l� #5 Building Square Footage: (existing/proposed) 1st FI i2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport /_ (Circle:Attached or Detached?) Other sq.ft. / Ce- 1I�� #6 Use of buildi '—' G-Z u! �" /I�JAIIZDesc�ibe wor�CfQr%.A NiC� Ooa n �Ivn #7 Type of Job: New Add Alt Repair Other,_ (hodviar Wme- #8 MOBILE/MANUFACTURED HOME INFORMATION O Model Year Make Model Wood �70-v-J• 161 Length Width Serial No. gPPrvved ► iner� #Bedrooms #Bathrooms Type of Heat Purchase Price$ #9 Indicate by circling the applicable_source Jd ter is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Mars Sattwate Seasonal Runoff Other MW Show following on the site plan Lot Dimensions Floof&ices Existing Structures Penes Structurg Setbacks Driveways (� Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Direction fN, S, E, W) Name of Fronting Street in relation to.piot plan APPLICANT TO DRAW SITE PLAN BELOW d Ton 04 APPOCAW l"O DRAW'T OPOGMPHY-PROFILE BEj_OW ��`� S `PZ DEPAWMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold AR?WvW Planning: Environmental Health: !:5600t&,'^T 04A on 16 MI Building Plan Review -;ps pit1cr- M b.i eA LC- occupancy Gtoup: - m Type of Cone: S-t.) Fire Marshal: Other: Special Conditions: Auxt7. tk5qb FbwjDA#1700 FEES ©e2 �Nrr�rs soe `S 4�D Building Permit . 00 Plan Check Plumbing Fee. Mechanical Fee -- Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection �(j Building State Fee Other Other Building Valuation: TOTAL FEE Plumbing Fixtures(S3 each) Fgg h; "its '�- -- (S6 each) No. CIRCLE FUEL TYPE: Gas, Electric, _2-'Bath Basins Heatpump, Other Bath Tubs &L Slpjl;: ,_„10 �t 0' E= ,_(_Showers Furn BTU LHot Water Htr Heatpumps - LLaundry Washer Vent Systems l Sinks /hlCy"I Spot Vent Fans _Floor Drains Boilers/Compressors _Laundry Basins HP Dishwasher Air Handling Units _Disposal _ cfm# _Urinals �Q, Fire Prot6ction Systems ; Other- _ Auto.Fire Alarm Sys 50.00 ixed Fire Supp. Sys -" 50A0 Permit Basic Fee 15.W Auto Fire S s -M 00 TOTAL PLUMBING $ Ng� Other Gas Outlets Wood,Gas, Pellet Stove NOTICE: TMS-PE MT BECOMES NtJI IL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED.I .NOT COM MENCED Wi IPH11N SO DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK DAVIS SUSPENDW OR Ai$ANDONED FQR A OF 1 PE OD TOTAL MECHANICAL $ - 8Q 19 AT.A & A N VIAFTER K IS COM- Mom•PHGIAF Of�C� . OF%%VW IS BY MEANS OF A FlAb li tii MSPEETION OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- 1 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 AMAWAREOFTHEORDINANCEREQUIREMENTSREGU- 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 CONFORMAN EREWITH.NO CHANGES SHALL BE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT MADE WITHO FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDI EPAR ,,,,, DEPARTMENT. X OWNE X BY DATE DATE `>�;:.