HomeMy WebLinkAboutBLD94-1483 EXTEND SIDING/ GUTTER - BLD Permit / Conditions - 10/20/1994 17
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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 FRAMING by date by date by
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by
date b
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date �,j LC , I Z,Z f by y U f: date by
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At*ot�636 Permit No.
MASO COUNTY
ta�
BUILDING PERMIT APP ICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 4 7-9670/1-800-562-5628
PLEASE PRINT
#1 Owner Phone# -4 z 7-%7o
al� dress A,/ Fire District#
ity St &ZA Zip q cl-4
Directions to Job Site .(/, to ;.a �'ir' ; o z r+��a ��,f''.► f-ac�� / -`�� ��
Z*00?1 on i
Owner Mailing Address `gy p 736V- S-79
City 1!4'0 St_64 Zip�IBSf�
Lien/Title Holder /Yf ,�t �a.�.•q fy!
Address
City St Zip
#2 Contractor Name Contractor Reg #pwiali90
Address soz # Expiration Date
City yw•o.. St &IA Zi ?FYn Phone#41Z�- 5V4--4606
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Cel No. 42 0
Legal Description(
#5 Building Square Footage: existi /proposed)
1 st FI!�� 2nd FI Al;d 3rd FI Z A Loft y� /
Basement_/ Deck 44YI #bedrooms__,,de i #bathrooms/
GarageAZ/ Carport_/ (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of buildinng �'oi;el �,,�.s c �'„r,o�.t Describe work
�a c.'/�'k-i / S
#7 Type of Job: New Add Alt x Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat
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 l by N S E Wi Di di Incate Directional , ,
Name of Flanking Street )
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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 No. UaL Fees
Showers Furn BTU
_Hot Water Htr s Heatpumps
_Laundry Washer Vent Systems
_Sinks Spot Vent Fans
_Floor Drains No. Boilers/Compressors
_Laundry Basins HP
_Dishwasher No. 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 $ Oth
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 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 BUILDING DE ME . DEPARTMENT.
XO XBY
DATE 9- a' DATE
FOR OFFICIAL USE ONLY:Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review
Occupancy Group: Type of Const: '5--All
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee 1 s
Other
Other
Building Valuation: TOTAL FEE
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
COURTHOUSE BUILDING III,426 WEST CEDAR STREET
P.O. BOX 578,SHELTON,WASHINGTON 98584
(206)427-9670 FAX 427-8425
planning landfill utilities
VENDOR NUMBER 1,10 0
DATE
ORDERED BY
DEPT AREA(JOB#) r i G
QTY. ITEM/DESCRIPTION UNIT PRICE PRICE
OF
.07
v,
CONFIRMED F7uNCONFIRMED LINE ITEM #(DESCRIPTION)
VENDOR: ALL.3-11LINGS MUST BE SUBMITTED PRIOR TO THE 6TH OF THE M NIN RDERTO FREIGHT
BE PAID IN THAT MONTH. NO PURCHASE ORDER SHALL EXCEED�j 1,000.00 INCLUD-
ING TAX&FREIGHT WITHOUT PROPER BIDDING PROCEES. P,
DUR RCHASE ORDER TAX
SHALL EXPIRE AND BECOME NULL AND VOID AFTER SIXTY(60) DAYS FROM DATE OF
ISSUE. T TAL .®
SPECIAL CONDITIONS:
i
APPROVED BY: DATE:
APPROVED BY:
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