HomeMy WebLinkAboutBLD95-0149 Mobile Home #27 - BLD Permit / Conditions - 2/3/1995 vl"t h uc' ll{e-L I'u'�J r"Yr49cj Permit No. $Id'7 6149
PoA�5 ,l-*tasMASON COUNTY
BUILDING PERMIT APPLICATION ,1
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT %� �✓
#1Wiwte
r \\w c�\� ��, , n c>Sc„ Phone#
6LLOev� Mca L N.o.. e park
ddress �e x, e-c„ rz l ace Z j Fire District# z
City Re��n .2 icy. St \
Directions to Job Site ' e i Set'
c'�vn r
plr\c care �1_S ��Jac- :0'e•1
o F 'the `R c, l r
Owner Mailing Address 1 ( c \ 2 2 K r2e�
City -?-, St t-") Zilp CO
Lien/TitleHolder Gtaecn-$zee— TXY\Cxnr
Address P O 3r^x 3 2`l h
City \-e A c
#2 Contractor Name Contractor Reg#
Address Expiration Date /
City St Zip Phone #
#3 If septic is located on project site, include records.
Connect to Septic? _Public Water Supply_Well Fc r Re cr rA S
� \ (3� y a3
Connect to Sewer System? Name of Systemy S To �tx�� her !
(If residential, proof of potable water is required)
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# arceI No. la'�� 2 - tiC) - 0C) c,G IStw) I�r (WLS
Legal Description GOI-der r'--�et\ motoi 1 Hov,-. e �n r1G
#5 Building Square Footage: (existing/proposed) Q CO
1st FI-(1l�l 2nd FI 3rd FI / Loft /
Basement / Deck #bedrooms� #bathrocF
Garage / Carport (Circle:Attached or Detached?)
Other sq. ft. / cn Cl)
c
#6 Use of building
n
UU
#7 Type of Job: New Add Alt Repair I47 1995 p
#8 MOBILE/MANUFACTURED�TMF INFORMATION *-ALTH SERVICES
Model Year I C Mace Model,
Lengthg8 Width aS Serial No. O
# Bedrooms # Bathrooms Type of Heat
Purchase Price $ ? `` ' to 5'Lo, i59. 7
#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
HQ �.
CCL
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs _N9_ Units Fees
Showers _ Furn BTU
Hot Water Htr Heatpumps
_Laundry Washer _ Vent Systems
Sinks Spot Vent Fans
Floor Drains Ug. Boilers/Compressors
_Laundry Basins \ HP
_Dishwasher \ AJQAir HandlingUnits
_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 $ Imo, 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
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 AWAREOFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATINGTHE 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
n
X OWNER X BY
DATE - I. 9 S DATE
F}R QFFIC3AL U (JNLI'-Accepted
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: SlAb c;C�-
o rd 11Zce �11115
Environmental Health: fJ
I
Building Plan Review
Occupancy Group:_ Type of Const:
Fire Marshal:
I
Other:
Special Conditions: FEES
Building Permit 10a �
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee 5Z>
Other
Other
Building Valuation: TOTAL FEE
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CONCRETE
MECHANICAL MOBILE HOME
Footings-Setback date by
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date by Gas Piping d
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Foundation Walls date by t y 76
date by INSULATION ate `
nal
MSLAB Insulation Floors date
by
date by date by date
FRAMING Walls FIRE DEPT.
date by date by date by
OTHER
PLUMBING
Attic I
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date by WALLBOARD NAILING
D.W.V. date by
date by FINAL IN PECTION
Water Line date , �byldate by
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping - date b 4
Foundation Walls date by Set Up
date by INSULATION dote by p
BG/SLAB Insulation Floors Finadate by
date by — date
FRAMING Walls by FIRE DEPT.
date by date by
PLUMBING date by OTHER
Groundwork Attic
date by
date
D.W.V. b WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping - date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Wells FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date by date by
D W WALLBOARD NAILING
date by date by
Water Une FINAL INSPECTION
date by date by date by