HomeMy WebLinkAboutBLD93-1504 ADD - BLD Permit / Conditions - 10/17/1993 1
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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 Walls FIRE DEPT.
date /4y Z by date by date by
PLUMBIN Attic OTHER
Groundwork date by
date by WALLBOARD NAILING
D.W.V.
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 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
# VE
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MASON COUNTY CEP 2 AVE
BUILDING PERMIT APPLICATIOI'�ENERAL SE ' ��
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 RV�CE
PLEASE PRINT
#1 Owner �UL ,DE,�.�I�F/1//S Phone#,.�Z�'� G�2�-- 927a
Site Address W.3 8l �� y'�/v"��/Z/��Z77 �'- ,4 Fire District#
City SF a/1/ St W,,4 Zip gffe
Directions to Job Site 4.4 T I//.4/v f//L Z-46C— W Z O T/4�!C-C- S-rie6E7"
4?"5/!/o 0E �o�ie7z� orz- SbvFy ) cvL -,oE s,4'G
Owner Mailing Address /lfW 6577V
city SE.4 TLC St w4 zip 96/4
.6ierd7itle Holder S/TE-7 OIt/L`Z) /NAZ4 VEHVIL.4//t,!M
Address 475 F4/lelo/V7' /eO rt
City 4,Aee 0J'W6i5(f7 St OR zip � D
#2 Contractor Name Contractor Reg#
Address Expiration Date / /
City St Zip Phone#
#3 If septic is located on project site, include records. //"4 .
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. 4ZO08� - 5-0 - OOOS
Legal Description LO 3 7-VIA/V 1//GL.4GE A.0 GOT
VOLUAWC—/O Off-?e-07Y, PAGE 97 .,*/D
#5 Building Square Footage: (existing/proposed) Gf/.4S�N6N
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / _#bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Use of building P,4/ZT- TIRE Zr,-' /lJc Describe work 40,01T/OlV
#7 Type of Job: New Add _Alt 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: N A .
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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
16t-7 /--7T.4CI-15.n
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
ti A iV 4 .
No. Toilets CIRG, E FUEL TYPE: Gas, Electric,
Bath Basins Heatp mp, Other
Bath Tubs No. Unit Fees
Showers _ Furn BTU
Hot Water Htr _ 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 $ 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 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 OF THE 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 BUILDIN PART T. DEPARTMENT.
X OWNE X BY
DATE DATE
FO OFFICIAL'USE ONLY.Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
i
Approved Cond. Hold
Approval 1
Planning:
1 , n
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Environmental Health:
Building Plan Review
Occupancy Group: Type of Const:
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
Other
Other
Building Valuation: 1 `4 0 TOTAL FEE ��_