HomeMy WebLinkAboutBLD2000-01218 REROOF - BLD Permit / Conditions - 9/18/2000 4
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i CONCRETE MECHANICAL MOBILE HOME
+? Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date
B insulation by INSULATION date by
BG/SLAFloors Final
date FRAMING by date by date by
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by {
1 '
1
J �
PERMIT NO: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275.4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner , 1 L__1 . , , Contractor Name
Mailing Add ss /}L-0 W Mailing Address 4!�F
City / State k4 Zip Code ��rs3'y City State & Zip Code s. /
Phone( Other Ph.( Ph.( 34o ) - iq they Ph.(
Lien/Title Holder Contractor Reg. # Gb/Doi d
Address Expiration__/ /_ /
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. bl / _/ <7)()20 Fire District/_
Legal Description_ ) 5 y
Site Address(Please include street name, strum er and city) P
Directions to site 5�,T I fv4.) mn + (oc IA LzF--t- v, L .Ita f )07—_QP. JTw.;
Will ti er be cut and sold in parcel preparation? (Yes/ wo
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial Jul No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ Replacement Unit ?(Yes/No)
Installer Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
apps7�W,/�JA
first obtaining approval.
X -.-,Date — � X iC�� _ 9—G -fo
date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
REV DENIEDDEPARTME CONDITION CODES
Building Departme o, 1
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES