HomeMy WebLinkAboutBLD94-1230 Mobile Home Replacement - BLD Permit / Conditions - 8/8/1994 7v3 '-r -: '^s ... T.S "^sr !? r•- 7. .'..` ...
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Permit No.
MASQN C04JNTY
BUILDING PERMIT APPLICA ON 4D 4'
426 W_Cedar/P.O. Box 186,Shelton,WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
wip
� ![ram: 7Phone# AA&- .Z 7 S y3 or W A
ite AddressAE' cP a 3 rn 6 W Fire DiS iCt#
City _ St A,
Directions to Job' WINOAF
f
O:!!wner IM ng dress
City StI,IAZipA tj t _
Lien/Title Holder
Address
City St Zip
s
i
s #2 Contractor Name Contractor Reg#
Address Expiration Date / /
City St Zip Phone#
#3 If septic is located on project site, include records.
t Connect to$NOW._f_Public Water Supplyf1/Ar�►
Connect to Sewer`$ystem? Name of System
(If residential, proof of potable water is required)
#4 1 No.aJ340 _-2_- e O 000
Description At-*,JV&j `►3Q�*sa-� - 1
#5 Building 91PW Footage: (existing/proposed)
2nd FI / 3rd FI / Loft /
1 Basement / Deck / #bedrooms / #bathrooms /
4 Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Wof building 101111111111be work
07 Job: New Add Alt Repair Other
#8 [Length
E/MANUFACTURED HOME INFORMATION
Year�_Maker Model,_
nq1 if._Widths+ nai No.2 f�13.�
"1ooms #Bathrooms Type of Heatj�t`7'ase Price$
#9 Indicate by circling the applicable so:�*;h
is on or adjacent to subject property:
River Pond Creek Stream Weti Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Peones
Existing Structures Fences.
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
kurre,o'I~.,Fla*Mg Stet ; , Indk*de DIref al 17y N, S; E, W)
Namo bf ,rontiPg S#fit 9 in n:to p t Milan
APPLICANT'TO IJ AVM SITE'f" BELOW
E
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOWf
1 qr
Plumbing Fixtures($3 each) - "aaigal Fixtures ($6 each)
No.Toilets CIRCLE FUEL TYPE: Gas, Electric,
y
—Bath Basins Heatpump, Other
—Bath Tubs �titl8
Showers Fum BTU
Hot Water Htr Heatpumps
undry Washer Vent Systems
pot Vent Fans
_Flo sins Ng..'
Laund in HP
Dishwashe N9.1
_Disposal
Urinals Ng..
Other — Auto.Fire ys 50.00
Fixed Fire Sys 50.00
Permit Fee — Auto Fire s 25.00
TO LUMBING Other
Gas lets
W , Gas, Pellet Sto
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORMIS NOTCOM- —
MENCED WITM 181)DAYS OR iF aONtRUGAON-OR P Basic Fee
WORK ISSUSPENDEDORABANDO""FO to PERIOD TOTAL MECHANICAL $
OF.180 ,DAY$ AT ANYTME AFTC MIQFBE COY-
Mom.PROF 4IAT OF.WORK IS BY
MEANS OR A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQIJIRE- I CERTIFY THAT 1 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 AMAWAREOFTHEQRDINANCEREQUIREMENTSREGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE E WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE 1NILL BE IN CONFORMANCE
CONFORMANCE THEREWITH.NO CHANGES SHAL,L$E THEREWITH.NO"CHAttGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING RTMENT. DEPARTMENT.
X BY
-q DATE
DEPARTMENTAL REVIEW
MOFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: 5CAb iCg-�- QC- (4 ' 19ckc
Environmental Health: elf
Building Plan Review *112
i
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 ,
9
Other
Other
Building Valuation: TOTAL FEE
-3
71
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