HomeMy WebLinkAboutBLD95-0788 Final Decks #27 - BLD Permit / Conditions - 6/9/1995 I
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CRETE MECHANICAL MOBILE HOME
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b Floors Final
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ON� 1 "COUNu� IYf r�tf f Pef 't NJo 1 Q�
0 9 1995BUILDING PERMIT APPLICATION qh�g
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE_.,,...e_SL-11 IV
I/'1tF __.__ -
�6
#1 #11tty
er t OEL OI�9�SOY/ Phone# 49 S 9C�le 5
Address Y E' oq Qr� L��JQ Ae--r' � Z`1 Fire District#gF:G.,Z"A AZ St I.UA• Zip�9 8
Directions to Job Site hl F �(J OF56L �a� EGfAS/2
p0 r1,,�.
Owner Mailing Address 5.4 m s AS A.bD J E
City — St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name��"ZF7 DI c I E S Contractor Reg #
Address 6&9 a 6 4,y L .) !/ Expiration Date / / -'re
City B7FzF-l" 'Gy7 St A, Zip Phone# / ?'
#3 If septic is located on project site, include records.
Connect to Septic? Public er Supply Well__
Connect to Sewer System? Name of System
(If residential, proof of otp ablo water is required)
j
#4 el No.J� �_ r bbb
egalDescription
#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.
#6 Use of building Describe work
#7 Type of Jo : New Add Alt Repair Other,- e K5
#8 MOBILE/MANUFACTURED HOME INFORMATION L��<6
Model Year/495 MakeLAM1Y Model rn6VOW 9"49r
Length 'q Ll Width A 0 Serial No.
#Bedrooms 3 # Bathrooms .2 Type of Heat:VuQA4cC
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
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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
r— ( C-
Plumbing Fixtures ($3 each) _Fek 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 INL. Boilers/Com ren ssors
_Laundry Basins _ HP
Dishwasher hL. 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. Mar
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 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- LATINGTHEWORK 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
EFOR1OFFICEAL'USE ONLY:Accepted by:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
11�, X Approval
Planning: ,Y,S S�rwt /J� `Se�br-ck �S l7 �✓It C1/ mS
OJLwIL sjY,Ac41A✓FS
Environmental Health:
Building Plan Review W��
(o_lQ-9
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check SC�,
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee 5 a
Other ( ��
Other
Building Valuation: TOTAL FEE
s
v
a r �
YxY � 5
t �
r
1 RECEIVED
`JUN 10 2004
3ELFAIR OFFICE
APPROVED
mil COUNTY ^ �
sirE P , rJNV4;1
NING T)�
C LAN % tQUIREU TO SEITE
GES SUBJECT TO APL
_ BY
27
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