HomeMy WebLinkAboutMIS95-0058 - MIS Permit / Conditions - 1/28/1995 t7
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CONCRETE MECHANICAL MOBILE HOME
Foot' s-Setback✓ date by Ribbons
date, l'6- �S by Gas Piping date b
Foundation Walls �t ��L�— date by Set Up
date -(a -1451- ' 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
Water Line FINAL INSPECTION
date by date by date by
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Permit No.'
MASONOUNT I�
l✓ BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 Q�V9 CO
PLEASE PRINT
#1 Owner's 9- "�i� _L'' Phone# 4.:Z7-0916
4 e Address �_� 1 1_ �_ d� iL�C� L&,n�'_
Fire District#
( `City 51-le47Z11-2 St o-4 Zip
Directions to Job Site 7-d EfI.CR-00 -
� t�`� iSLD LET D,J (2 , 4e- o-�' hk
G.�fzT S�DEi O� l'C®
Owner Mailing Address
City /C-) St Gv/f Zip
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name :;F Contractor Reg # � �5 �
Address a2aX IqMy 4V7 Ulm Expiration Date
City St GUg Zip �76�5785r Phone#
#3 If septic is located on project site, include records.
Connect to Septic?__X Public Water Suppiy_�( _Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No.5�W e - � - 9�3/ �aB
egal Description � A— ZZ17 3-iq 5orv� 1�/i ocCK�
#5 Building Square Footage: (existing/proposed)
1 st FI /;��,/-)/ S4 FZ- 2 n d FI / 3rd FI / Loft /
Basement / Deck / S4 f-7-0 bedrooms / #bathrooms 13-1 I�FT`
Garage sa / y�r Carport / (Circle: Attached or Detached?)
Other sq. ft. /
#6 Use of building .5 —Describe work 101t�
'Ve"w.s—,
#7 Type of Job: New J Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model ear Make I
Length idth erial No.
# Bedrooms # Bathroo s T of H at
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
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
IDD`/�-OOrAa,C
DO�APAO%',j �
1 _ J�
LoT �37 way
r
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 eachl Fee Mechanical Fixtures ($6 each)
No. 2 Toilets CIRCLE FUEL TYPE: Gas, Electri
2 Bath Basins — Heatpump, Other
Bath Tubs No. Uni des
1 Showers Furn BTU ip
L_Hot Water Htr J _ Heatpumps _
/ Laundry Washer Vent Systems
Sinks Spot Vent Fans oZ
._Floor Drains No. Boilers/Compressors
Laundry Basins _ HP
/Dishwasher ./ No. Air Handling Units
4L76isposal — cfm#
Urinals No.. Fire Protection Systems
,Other — Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _III Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ 60No. 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
MENNS 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 �" X BY
•-
DATE — DATE �s--
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:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
'3 Plan Check
SZS
Plumbing Fee r�8
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other�OWESI`
Other �,y
Building Valuation: TOTAL FEE