HomeMy WebLinkAboutBLD93-0559 - BLD Permit / Conditions - 6/15/1993 0
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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 by
D.W.V. WALLBOARD NAILING
date by date by t�
Water Line FINAL INSPECTION
date by date by date /� c9� a'by�
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Permit No
MASON COIINTY'
r _ BUILDING PERMIT A PLICATION
PLEASE PRINT
} #1 owner Ph ne# �`c� SS3l�-- /2_Z n
Site Address 2 -I 0 0 C � 0 , cX I a --k Fire District #�
City L� e "I, �'�.e \ ��►'� St c- . Zip
Directions to Job Site eLk c :*- -- ec? Tl'C
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Owner Ma ing Address ld
City P� ,�_ St O /�-c Zip 7 77-7 `�
Lien/Title Holder o. ., ('o r
Address Z 'L L c n 1- 4�'
City St a- Zip �d�Z
#2 Contractor Name 2n-�t1 Contractor Reg#
Addresse_?0 3 ge' �- Expiration dateCityv-�i.�.J St(� `7� Zip 4 Y� Z Phone y 6
#3 If septic is located on project site, include records.
Connect to Septic? ' � Public Wat r Supply_, t� Well /V 4
(If residential, proof of potable water is required)
#4 Parcel No.,/ t)v .k -7�- C/ n 7
Legal Description 'T, 2 b Ili
y , ► 7
#5 Building Square Footage:
1st F1 2nd F1 3rd F1 Loft Basement
Deck #bedrooms #bathrooms Garage .54 `/ Carport
Garage/Carport: Attached or Detached
Other#6 Use of building W tit" d�� Describe work
#7 Type of Job: New Add Alt Repair Demolition
Re-Roof Bulkhead Other
#S MOBILE HOME INFORMATION
Model Year Make Model
Length Width Serial No
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
IV/,river pond wetland seasonal runoff
other
RAW dip Akv>RI&U
A0�49350%i
Yy
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F9 IRW §�Tfw IFAM
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Plumbing Fixtures Fee Mechanical Fixtures
No. Toilets Primary Heat Source (ctrcte type)
Bath Basins Elect/heatpump/other
Bath Tubs
Showers NO. FEE
Hot Water Htr Furn
Laundry Washer Heat Pumps
Sinks Vent Sys (Central)
Floor Drains Vent Fans (Spot/Whole)
Laundry Basins Boilers/Compressors
Dishwasher HP
Disposal Air Handling Unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee
TOTAL PLUMBING $
Other
Gas Outlets.Hookups
Wood/Pellet/Gas Stove
Other
Permit Basic Fee
TOTAL MECHANICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONIRACTORS AFFIDAVIT
I CERTIFY THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE I CE rIFY THAT I AN A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAY RCW 18.27 , AND AM AWARE IN IFE STATE OF WASHINGTON AND I AN AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDIANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT 1S ISSUED AND THAT ALL WORK DONE WILL BE IN THE 'PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEP�TMENT. I
X OWNER X BY * '`+> /
DATE DATE t-
Return permit to: Department of General Services
426 N. Cedar/P.O. Box 186, Shelton, WA 98519 427-9670/1-800-562-5628
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