HomeMy WebLinkAboutBLD11980 Mobile Home - BLD Permit / Conditions - 2/2/1982 BUILDING PERMIT APPLICATION
MASON COUNTY JA 0/� -d l - 1040
P.O. Box 186 Shelton, Washington 98584
426-5593 � ^ Q�
DATE ISSUED
PERMIT NO. //V-�
OWNER NAME MAIL ADDRESS qTY ST TE ZIP PHONE
- - t
DIRECTIONS A_
TO JOB SITE ` - T. r &'v
LEGAL (❑SEE ATTACHED SHEET)
DESCR. !7 T `
NAME MAIL ADDRESS CITY✓t<STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: / i J� 4102-1 ,1
Valuation of work: $ PLAN CHECK FEE PERMIT FOR.
SPECIAL CONDITIONS
BEDROOMS DECKS----- CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
SEPARATE PERMITS
NO. OF STORIES BASEMENT ElATTACHED ❑ OR AIR CONDITIONING RE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMtNOEDWITHIN 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 OF'F1,C USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES A D NO
Lic. No. Date ZONING
PLANNING D T.
OWNERS AFFIDAVIT EALTH DEPT.
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 16"UILDING DEPT
of the Mason Cc ty ordinance requirements for A =
wh this perm f ssued and that all work done will ROA ACCESS
b F 'conform thVrewth. MOTOR VEHICLE PERMIT
� � � /8 (CATION A EDDY PLANS CHECK BY AP VED FOR ISSUANCE
Owner Date
r'
P CHECK VALIDATION CK.. M.O. CASH PF9RMIT VALIDATION CK. M.O. CASH
PRINT
FOR BACKER ON SHEET SAME AS BACKER ON SHEET . EXCEPT gACxeR. RE LAR TUMBL� STYLE
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APPROVED
MASON BUILDING INSPECTOR
RANGES SUBJECT TO APPROVAL
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2 2.1411 R Dr4rrn S
lCi8 : APPLICATION NO.
DATE aw?"'6:2" d
SHELTON PUBLIC WORKS DEPARTMENT UTILITIES APPLICATION
PLEASE PRINT ONLY
s
APPLICANT
/Y I ADDRESS TELEPHONE
ADDRESS OF HOOKUP
LEGAL DESCRIPTION /aG:IH �7� L7h'� �lJQ
TYPE OF HOOKUP: SINGLE FAMILY RESIDENCE DUPLEX MULTI-FAMILY
NUMBER OF UNITS COMMERCIAL
WATER HOOKUP: METER SIZE-- %?C-�` —SEWER HOOKUP: SIDE SERVICE SIZE—
1 HEREBY UNDERSTAND THAT AN ASSESSMENT MAY BE ON FILE WITH THE CITY QLERK FOR MAIN
EXTENSION FEES AND THAT I WILL PAY SUCH FEES IF DUE, BEF RE HOOKUP IS
� I
SIG ` - 1
DEPAR ENT USE LY
SEWER: HOOKUP COST WATER: HOOKUP COST_ ( Yl��
ASSESSMENT YES_ NO_ ASSESSMENT YES—
NO-TOTAL DUE TOTAL DUE
DATE PAID DAJE PAID
REMARKS:
�
SEWER-WATER SERVICE RECORD
SEWER: Location—ft. N.E.S.W. from WATER: Location—ft. N.E.S.W. from
M.H. at valve at
Ave. Ave.
on St. Other: on St. Other:
LABOR BREAKDOWN LABOR BREAKDOWN
Hrs. b S Hrs. @ $
Supervision Supervision
EQUIPMENT RENTAL EQUIPMENT RENTAL
z Hrs. a S Hrs. 6 $
Hrs. a S Hrs. 6 $
Pipe—Size—Kind Pipe—Size—Kind
Feet Cost Total Feet Cost Total
Saddle
Corporation
Curb Stop
Valve
Adapters
Ells
Nipple
Tee
Bushings
Reducers
Couplings
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Smith, Ja6k* ►� �'12St8p
(877-9702) 2/2/82'
Lot 7, Block 10, Mt. View Addition to Shelton.
222Wj* Adams Street, between I & J, by car wash
Mobile Home Contractor:
Self
$13,468.00
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