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HomeMy WebLinkAboutBLD95-1094 Final Replace Mobile Home - BLD Permit / Conditions - 9/19/2005 I Permit No. MASON COUNTY �P BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT ' c� #1 wner e.=% 'C= �`Gtis l�' Phone# i Address /1� 2 O �G/1�L mil' 2- Fire District# `Z- ity , C,� r4 i 2 St LC1 Pq Zip Directions to Job Site v*-r r &/,--5 � �6c�s4� K' off �w� 3oa , I(J Dy/7-0 c;2:l tl-l t / 'vim!Z j'c re" /DU' ' O'n "ezS Owner Mailing Address , 2- /! City '�' ! . f� �i St l<.fi7 Zip y 4?l Z= Lien/Title Holder Address City St Zip #2 Contractor Name D` )' �O'-/ C' '' L �;! ' . Contractor Reg# L- SCycl� 097'tZ Address _/�G /1 oy �*4n "7 7 Expiration Date ' / 3Z /S City o'-s"a St Zip Phone# �1.� -IJ-5 7 #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well. Connect to Sewer Sy em?�Name of System t4�rI/ �'/ �' c✓ l!�' �'C' (If residential, proof of potable water is required)46 # el No. Z 3�5 I - 2-3 - ©14 L al Description 2o7 � #5 Building Sq re Footage: (existing/proposed) 1st FIB/ 2nd FI / 3rd FI / Loft / Basement' / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq. ft. / #6 Use of building ;�� �` c_<__ Describe work #7 Type of Job: New Add Alt Repair Othe `« Cc f t c c it f #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year 9 5 Make odel J. -) Length i" Width 2- / Serial No. jC" - # Bedrooms_#Bathrooms _Type of Heat Purchase Price$ ^ J c' `w #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 Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW 17 APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW ,a F��T -+tires ($3 eacbl Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Unita 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 No. 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 OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE 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. I X OWNER X BY DATE DATEX4�i t NIL.. Acce ted b : r Date: �7 .FOR OFFICIAL USE O at y DEPARTMENTAL REVIEW FOR OFFICE USE ONLY ` Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review h'1 G- ec a Occupancy Group:,R= Type of Const: Fire Marshal: Other: Special Conditions: Al uST FEES M 1N /0 S"tT-t�1i4c/C 1=i2 ,�,� Building Permit Q. - r�t� ALP � -77Ye- ��/ C Plan Check Ar- 7-HC o o r s Low c Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Building Valuation: TOTAL FEE 04/20/2006 09: 59 3606925569 PACIFIC NW TITLE PAGE 01/02 PACIFIC NORTHWEST TITLE 9927\,56ceibgT}'Roa2 N 1L P.O.Box 360 Sil%w"e_Wi&hmgwn y3?9? (36D)692-1341 F=(360)692-3569 FAX COVER SHEET FAX SENT TO: FAX NUMBER(340-2 Z27-219� COMPANY:---., DATE FAXED: TIME- Z FAX SENT BY: DEE FERG{JSSON (360) 692-4141 Ex7- 288 FAX: (360) 692-5569 9927 MICKELBERRY ROAD NW SILVERDALE, WA 98383 NUMBER OF PAGES INCLUDING THIS COVER SHEET: PLEASE CONTACT ME IF YOU DO NOT RECEIVE ALL THE PAGES. COMMENTS: c 1 1 04/20/2006 09: 59 3606925569 PACIFIC NW TITLE PAGE 02/02 AAA u ', ' MA-SO ' �i/DWI/\ri/;N I {! i ... lfll8EG11'� �� ol Lr.Mae loobiflih � , p '1�: StCell i Is�r;�•ei,!';�y: , Mkt mill CArRD,i R A tibo V �Miov . 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