HomeMy WebLinkAboutBLD96-0533 Mobile Home #6 - BLD Permit / Conditions - 5/7/1996 Permit No.
MASON COUNTY ,
BUILDING PERMIT APPLICATION �����
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 (�
PLEASE PRINT
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#1 Owner Q E d Phone it (Q�� �z
Site Address 02 Fire District#
City St Zip
Directions to b Site
Owner Mailing Address e �3
City St Zip
Lien/Title Holder %
Address
City - �q . St d Zip
#2 Contractor Name ,c �� s/ (G,��r� .� ./; Contractor Reg#�_
Address „�r3c ] CDT
Expiration Date_ _/ _
Cityf-
St 4:�' Zip Phone# �/�-
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#3 If septic is located on Froject site, include records. � �=
Connect to Septic? Public Water Supply ' Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. !, ' - -6 _
Legal Des ription '
#5 Building S uare Footage: (existing/proposed)
1st FIQl� / 2nd FI / 3rd FI / Loft /
Basement Deck / #bedrooms iP `#bat o s �d
Garage /-,__ _Cacpoct----- / (Circle: Attached or Detached?)
Other sq. ft.
#6 Use of building scribe*R k
— YYYY/
y �
#7 Type of Job: New / Add—Alt—Repair— Other ��
#8 MOBILE/MANUFACTURED HO INFORMATIO
Model Year Make odel
Length Job Width Serial No.
# Bedrooms #Bathrooms Type of Heat
Purchase Price $_::Q�/
#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
FShow following on the site plan
Existing
ensions Flood Zones
Structures Fences
re Setbacks Driveways
Lines Shorelines
ge Plan Topography
Septic Systems Wells
Proposed Improvements Easements L:lndicatel by (N, S, E, W)
Name of Flanking Street to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
C�
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: mlolal u } 1UVVS���C'J\ Se}1occy m5
SAS �
Environmental Health:
Building Plan Review MU--4
S-r 6.96
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Occupancy Group: Type of Const:0"
Fire Marshal:
Other:
Sp nditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee y 60
Other
Other
Building Valuation: TOTAL FEE
Plumbing Fixtures ($3 25 each) Fee Mechanical Fixtures ($6 50 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bat asins Heatpump, Other
_Bath Tu s No. nit 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 — c1m#
�, Fire Protection Systems
Urinals
Other — Auto. Fire Alarm Sys 50.00
_ Fixed Fire Supp. Sys 50•00
Permit Basic F e 16.25 Auto Fire Sprink Sys 35.00
TOTAL P UMBING $ No. Other
as Outlets
Wo d, 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 16.25
WORKIS SUSPENDED ORABANDONED FORA 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 BUILDIN DEP RT T. DEPARTMENT.
X BY
X OWNER q
DATE 12q O=Atl DATE
yc
FOR OFFICIAL USE ONLY: Accepted tay: _ ✓ 1�ee
GOLDEN BELL MOBILE HOME PARK
N.E. 20 ROESSEL RD. BELFAIR,WA 98528
PHONE#(360) 275-4623
DEPT OF GENERAL
P.O. BOX#186
SHELTON, WA 98584
As required, we are sending you a notification of a new lease agreement with
the following new tenant. Lease agreement will commence when their MOBILE HOME
arrives on our pre-existing lot. If you have any questions please call during normal
business hours.
Legal Discrepton:
Lot 20 Sam B thelers- home garden tracts. Volume 4 page 20 RECORDS MASON
COUNTY.
PARCEL NO- 1//2332-50-00050
New Tenant Name: � r1n a tL n,1/R fl Lq�
New Tenant Lot: _
THANK YOU,
Dede Schattenkerk
Mgr.
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Fgundation Walls date b Set Up
date by
date by INSULATION Final
BG/SLAB Insulation Floors
date by
by
date by date FIRE DEPT.
FRAMING Walls date by
date by date by
OTHER
PLUMBING Attic
Groundwork date by
date b
WALLBOARD NAILING
D.W.V. date by
date by FINAL INSPECTION
Water Line date by date by
date by
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