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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback 'ry date by Ribbons
date ` ��� % by, ti 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 PLUMBING by date by date by
Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by I
Water Line FINAL INSPECTION _ I
date by date /���� by date by
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Building Permit MASON COUNTYI
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTIO NOTICE
Job Location Ile 7-
This structure has been inspected by Maso County Building Department
and the following VIOLATION of County La vs and Ordinances has been
found:
Items listed below, must be rrected to gain code compliance
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You are hereby notified that the above corrections shall be made BEFORE
PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to /
Department
Date J Inspector u,5 7rc-/
DO NOT REMOV T
HIS TAG
Permit No. �a
MASON COUNTY
BUILDING PERMIT APP (CATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 4 7-9670/1-800-562-5628
PLEASE PRINT
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#1���Se
r P one# Z(G
ddress A Cs au' Fire District#
City - ' ti St 1,.� Zip _ '��
Directions to Job Site
Owner Mailing Address V-\
City St Zip
Lien/Title Holder
Address C
City vtc St ZipC[CQQ3-aI99
#2 Contractor Names Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? �C)_Public Water Supply Well
Connect to Sewer System?-ND—Name of System
(If residential, proof of potable water is required)
# arcel No-qzcc) . - I_t - �® r�
Legal Description �Z . T . 0D 9 C:
#5 Building Square Footage: (existing/proposed)
1 st FI 1-3 2 / 2nd FI / 3rd FI / Loft /
Basement_ / Deck / #bedrooms / #bathrooms /
GarageZ4?,3(p / Carport / (Circle:Attached o Detached.
Other sq. ft. /
#6 Use of building \ i�j x Describe work
` Y(�\ n \4{ e\ \ 1\ �P
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HO�MEMFORMATION
Model Year , Make oo e` DEAO; ,
Lengt Seri I No.
# Bedrooms a reotns� Type of Hea l�
Purchase Price $ Cam`
�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 asonal Runo 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
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) FPg Mechanical Fixtures ch
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins He tpump, Other
Bath Tubs No-.- unk Fees
Showers Furn BTU
_Hot Water Htr Heatpumps
_Laundry Washer _ Vent Systems
Sinks Spot Vent Fans
_Floor Drains No. Boilers/Qom ressors
_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 $ No. 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- TOTAL MECHANICAL $
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 OFTHEORDINANCEREQUIREMENTSREGU-
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 DEPARTMENT. DEPARTMENT.
X OWNER , f X BY
DATE -/ ` ( DATE
FOR OFFICIAL USE ONLY:Acceptetl by. Date.
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
c
Environmental Health:
OWNER/BUILDER TO ASSUME ALL
RESPONSIBILITY IF DRAINFIELD '1
AREA IS ENCUMBERED.
Building Plan Review
Occupancy Group: —� Type of Const: —
Fire Marshal:
Other:
FEES
Special Conditions:
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee �aU
Other deAd-- 0�
Other
Building Valuation: G, �` TOTAL FEE