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HomeMy WebLinkAboutBLD95-00938 Cancelled Mobile Home - BLD Permit / Conditions - 6/29/1995 '• //c 3 7 0 '�I d q 5•vq�S Permit No. " �i�p4�� MASON COUNTY � BUILDING PERMIT APPLICATION �10d W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 QjPLEASE PRINT1;��426 #1 r —/�7 'Q C/7 l�i7s� � Phone#� 071 7 Si ddress 3 D L /P Dom/ L Fire District# Z ity Fig vq St Zip Directions to Job Site �tJ•Ps 1— 1F'I�d w► �1 aE G Fro t �"c/I y2-�^ t-c) y v�4/oI IA Y4 Fps���PD S� w G Vq re- Le-o A,-" Owner Mailing Address ' Ii9�✓�T. y� _ City 1001pr St Zip lam. Lien/Title Holder Address /��- Dx Z 9 city St ( Zip 9 O #2 Contractor Name G-�` -� C' '�'? Contractor Reg#G'-f �/Or09756,2 Address �y /14or- Expiration Date 7 /_2-4 / .9j— City V� -x'? St LJ Zip PZW7— Phone# J .�J'1 J�7 #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System oe/'—e' (If reside ial, proof of potable water is required) NGTE: /vFvJ WELL 7 PRaoF OF PD-rJ S ^ IS FoR2Ti, PLrPSE OK THK\A Ake- f c�c �E'PT. �-�,o,v�KS �jy� C;ItiI'LST loH 6 � ConTWCT #4n cel No. Legal Description Za lu PK7 io+- 1 0 #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / EJ #6 Use of building De work ow r — #7 Type of Job: New Add Alt Repair Other N m #8 MOBILE/MANUFACTURED HOME INFORMATION M Model Year 91 Make! ! odel Lr/'4�L Length S6 Width Z& Serial No. d m #BedroomsJ�# Bathrooms e2 Type of Heat LGu ie. M Purchase Price$-rQ omZ> #9 Indicate by circling the applicable source if anywater 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 I 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 r 4. o , � / s• 22:7 lO 14-� 3M' APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Sc QA Plumbing Fixtures ($3 each) Feg Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. Units Fees _Showers _ Furn BTU _Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems _Sinks _ Spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins HP _Dishwasher No. Air Handling Units _Disposal _ cfm# _Urinals Ng,, Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No.. Other 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 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 OFWASHINGTON 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. DEPARTMENT. X OWNER X BY DATE DATE I FFIOI�L I 1 t lL 'A eft �' Eaate : ' DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: "1/IZ Environmental Health: A a 111 n R-� s r� Building Plan Review "Ar(2 5Fe-T 6Aig-k C004L aJo. T lit T Iil.l 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 xe-1 4A Other Building Valuation: TOTAL FEE MASON COUNTY DEPARTMENT�OF41EALTH c' s �. .... :..�..._ POST:; OFFICE. BOX 1666 SHELTON, WA 98584 (206) 427-9670 FAX 427-8425 APPLICATION FOR DETERMINATION OF.ADEQUACY Revised 09/01/92 INSTRUCTIONS 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system utilized. 3. Submit completed application, with attachments to the health department for review. PART 1: APPLICANT/PARCEL IDENTIFICATION NAME OF APPLICANT DATE MAILING ADDRESS f 3 3 TELEPHONE (W ) Z 7 S-G 23 d City 9tat� Zip (E ASSESSOR'S PARCEL NUMBER I Z 33 ! °Z 1 'v-Zl SUBDIVISION (If Applicable) Z3 LOT ' Z TYPE OF WATER SYSTEM (Check One) ' REASON FOR APPLICATION (Check One) Public/Community Water System Building Permit, Single Family Res. Individual System, Drilled Well ❑ Building Permit, Commercial ❑ Individual System, Dug -Well Building Permit, Replace/Remodel ❑ Individual System, Sprinq ° ° >°- Land IIse Application ❑ Name Individual System, Surface Water Type ❑ Individual System, Other Other PART 2-A: PUBLIC WATER SYSTEM _ >na!!!a!aleuaamuuumaaaaaanaaaaau!l�ain��uilaauaniaaaulu!!aa!!!!!!sulunuualuuluauuaalaaaaauaaa!!!:!!aala! NAME OF WATER SYSTEMt_ °"WFI ID :7. �0'2 ; t �' se/'t M The water purveyor for this system has previously filed a certificate of water adequacy with the health district. 13�/am manager of the above referenced water system. The water system has DOB approval for 2--service connections, with connections presently in use. The applicant has approval to connect to this water system. Service of water to the applicant for domestic purposes is consistent with both the water system plan and the water right permit presently in effect. water lines are available to the applicant's property line, or the applicant has made satisfactory arrangements to extend the lines. 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INO/C.ATer e/rC L4M t .+wo 3I�Ir+� � r'T�OHOIf pier- /.4LT /�IQ/f OLOClG eJ I/IY SLY 0MAC*cm r ��}♦tip .Y�. /'LAIM4►fY r' _, CtGCO !f!lfT�L!•O .�4d.4/N2lT L r� OLGG7C e� M� /rt ��*40-"-ORT r I S l Tli f*P%0W=Ar .4 UAzhzp=/,,w ARTf 1 i"SILL ommm .4~A4ojut,ul •• �1�1r.4 ftAO�CO . ~a'a� ' • NN fa'IDrV!'.�CT di'. maw S&7PWA TWO tt•Moor s air-r�/ro r APPROVED " MUST MEET All CURRENTIAA90H BUILDING INSPECTOR WASHtNGTON STATES CODES [iiA[iiECT T �lP9't�i+� k p THESE tw¢ ,vim, It p4 � �}° ( } ✓� 11 ' MEMMMMPM MASON COUNTY BUILDING III 426_W.'CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 ORRECTION NOTICE Job Location _ .3*20 1,aj say-, 1, jw f`Q This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be corrected to gain code compliance 2. L GnIYe r'i S cL Ar'e-S 120 '14 3. �q-ff Y14a jecw-'- /- «� e- You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑OK to Department t Date Inspector L� NOT LSO REMOVE THIS TAG