HomeMy WebLinkAboutBLD93-1609 Mobile Home BLD11752 #39 - BLD Permit / Conditions - 10/1/1993 MASON COUNTY _ —
BUILDING PERMIT APPLICATIO ocI 93
6 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-GEI46eAL SERVICE$
PLEASE PRINT --- i ocm �}-
�/ �(#1 Owner Phone
�'P m ��' � �
Site Address 1 zL �t r l + 3�' Fire District#
City �D i`J i P St A zip 11f.5 3/
Directions to Job Site
Owner Mailing Address
St Zip
City
Lien/Title Holder
Address
Clty St ZIP
Contractor Reg
#2 Contractor Name f+rr c ��
#
Expiration Date /
Address
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic?_><,_Public Water SupplyX=—Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. r � '57D, I0 0(56-D
Legal Desrrgtta �
#5 Building Square Footage: (existing/proposed)
1 st FI / 2nd FI— �/ 3rd FI
Basement / Deck' _,a1� t_#bedrooms / #bathrooms /_
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft.
#6 Use of building E Describe work
#7 Type of Job: New_- Add X Alt Repair Other_
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year _Make �- . f '"Xdel -
Length ((„U Width_J 3�/Serial No. I S
# Bedrooms _# Bathrooms= Type of Heat r I c_ _p I C
Purchase Price $
#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 ��%}
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. UnitsFees
_Showers — Furn BTU
_Hot Water Htr Heatpumps
—Laundry Washer Vent Systems
_Sinks Spot Vent Fans
_Floor Drains NQ. Boilers/Comer or
_Laundry Basins — HP
_Dishwasher No. Air Handling Units
—Disposal — cfm#
_Urinals NQ Fire Protection Sy is em
_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- 15.00
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee
WORK IS SUSPENDED OR ABANDONED FOR APERIOD 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 BUILDI EPARTIIIvENT. 1 DEPARTMENT.
XOWNER �I—IL�n-P -�-c� � XBY
DATE % 7 DATE
FOR OFFICIAL USE ONLY:Accepted by: Date: �1 6
* c) (
DEPARTMENTAL REVIEWS
FOR OFFICE USE ONLY ��
Approved Cond. Hold
Approval
Planning:
Environmental Health: G2 uh m
Building Plan Review =LN;i 4L Jh2 ;yr (r n�c y �2 r q��g6 isp13
Al L41-r im g f N T Air✓ e c r Kr-�
veti Occupancy Group:R-3 �ef3'L pe of Const: S-A'
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit /oc wog tx 2S s / 2s, p-0
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee rj S ti
Other
Other
Building Valuation: /:�r�� TOTAL FEE /3
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
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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BUILDING PERMIT APPLICATION � ?j
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED l / -
PERMIT NO. 1176 lz
OWNER NAME MAIL ADDRESS CITY B STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL 3� (C SEE ATTACHED SHEET)
DESCR. �IFI K gF IL-4' 1 WRS/'/.
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
USE OF
BUILDING f).n,15"j N C'y
Class of work: NEW ❑ ADDITION CI ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
STALL O '2
/z/
7Xia �
Valuation of work: $ /// �.50 d PLAN CHECK FEE PERMIT FEE / aS
SPECIAL CONDITIONS:
BEDROOMS_ (DECKS CARPORT NOTICE
BATHROOMS TOTAL SQ. FT._ GARAGE '.I
ATTACHED NO OF STORIES BASEMENT :7 J L
OR AIR CONDITIONING.
PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SQ. FT. _ FIREPLACE C DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered Contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT( SHORELINES T
SEASONAL L FLOODPLAIN
Firm E.D. NO. S.E.P.A. G
By— Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. -W-
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be jinn conformance therewith. MOTOR VEHICLE PERMIT
�K AP CATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner_ (,•A�.[E VT'url[ Date .`.�,Jltily�
L
5
PLV CHECK VALIDATION CK, M.O. CASH ERMIT VALIDATION CK M.O. CASH