HomeMy WebLinkAboutBLD94-1279 DECK - BLD Permit / Conditions - 10/4/1994 00
00
of C:
Cf)
:D7
cn
on
OC)
-0 Q-
Ol
00
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 FIRE DEPT.
date / Walls
/ by date b date by
PLUMBING y OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date /r—>�—�� by ate by
OD
cn
7, 7:-
0 Q-
N)
co
cn
co
Q Q
co O
O (n
x � OoC) O
D z
CD oo
O (c)
Q O
C
C/)
Q � z
—�
o �
0 cl
CYI �
OD
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 �7
#1 wnerL Phone# ( C �� 7 _ i /
T
Address '� I � Fire District#
St Lk
tions to Job Site i.�-'
W t02 ,t «
Owner Mailing Address
City ��Q e��� St_�Q�Zip (
Lien/Title Holder ZA
Address
City St Zip
#2 Contractor Name ELrQ ��� `-' Contractor Reg# r"_YOtZGMq P-(41(7-1
Address (Oj?2•C> 2��� RUC, e-7 _Expiration Date_ /-3j �
City —7JfC'_>�`C�(Y�. St QC, Zip Phone —�' _'�5
#3 If septic is located on project site, include records.
Connect to Septic? '�Z_Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 rcel No. - - UU (2
`gal Description
#5 Building Square Footage: (existing/proposed)
1st FI 2nd FI / 3rd FI / Loft /
Basement / Declk / #bedr ms / _#bathrooms
Garage / Carport` / cle:Attached or Detached?)
Other sq.ft.
#6 Use of buildin9 i Describe work
#7 Type of Job: New _Add Alt Repair Other _ .
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model , 1 �gg4
Length Width Serial No.
# Bedrooms #Bathrooms Type of Heat
Purchase Price $ `C
#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
Fi.�6 _.._ 300� ILL q5tj
/ zc, I zo
v �
"7 A
r
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. jLaL 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
1 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 1
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE 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
F(}I QFIGIAL USE ONLY:Accepted by: Date
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review n
Occupancy Group: Type of Const: 7—r
Fire Marshal:
Other:
FEES
Special Conditions: rr��
Building Permit ( w •vV
Plan Check 5
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee ,sp
Other
Other
=BLflldinguation:` TOTAL FEE 35