HomeMy WebLinkAboutBLD94-0608 DECK - BLD Permit / Conditions - 5/24/1994 OQ
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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 PLUMBING by date by date by
Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL-INSPECTION
date by datEq—[��4-1
by date by
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner Ka/V
Phone# y,2 G` ,
PPA Fire District#_- �' T
Site Address (Al- I�� / .[� t�r�>' > St VAS Zip c2gS f
city ; x VAt'
Directions to Job Site AK " "
tr 3 4 q _ AOC 5,ro.0 cap:/
? 7 iLL iJ �Od/ /rVvF AO Hi AC J
L✓/tL s C/AQCL t Af?M/ k
Owner Mailing Address 1114 N�_E
St Zip
City
Lien/Title Holder
Address St Zip
City
#2 Contractor Name Contractor Reg #
Address Expiration Date-/ /
City St Zil k Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply � Well y
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. 1000% - 77 - 001420
Legal Description lu, o of- I o r ue V4 o F
_
tv ESQ, �✓a M
#5 Building Square Footage: (existing/proposed)
1 st FI !b iQ l 2nd FIB_/ - '"` 3rd FI Loft
Basement e / Deck ,9' _ / .2,V/01,#bedrooms / ^r` #bathrooms /
Garage__/__ Carport - "' / � (Circle: Atta ed or Detached?)
Other sq. ft. /
#6 Use of building __�.
�� ^r� Describe work �
#7 Type of Job: New Add Alt Repa Other
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BILE/MANUFACTURED HOME INFORMATION#8 MO 1J
Model Year � Make 6U L,4- Model Q
Length / j� Width 4?% ' Serial No.
C S�
# Bedrooms *� # Bathrooms Type of Heat
Purchase Price $ _ --&- G
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property: �- y
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
e
V£
"lAy
� XV,
1C .�. f311146�/
iPf�a}OS 50 N y
Dicr�
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
i n�ro
PlUmbiw Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilet CIRCLE FUEL TY E: Gas, Electric,
_Bath Basi Heatpump, Ot r
_Bath Tubs No. Fees
Showers — urn 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
— ixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 Au t Fire Sprink Sys 25.00
TOTAL PLUMBIN her
Gas Outlets
Wood, Gas, Pellet tove
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 BUILDING DEPARTMENT. DEPARTMENT.
X OWNER .z' •� X BY
DATE DATE
xx
FOR OFFICIAL:USE ONLY:Accepted by. Date•
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY F
Approved Cond. Hold
Approval
Planning:
Environmental Hea'''
OWNER/BUILDER TO ASSUME ALL
RESPONSIBILITY IF DRAINFIELD AREA
IS ENCUMBERED.
Building Plan Review ,p-} chttak . eA&-, W
Occupancy Group: " YM =`r Type of Const: P ct{�i _►,�_
Fire Marshal
i
Other:
Special Conditions: FEES
Building Permit ,
Plan Check s
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: ' I TOTAL FEE
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