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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback a/"P«cavnr.4csow- 5,"&As date by Ribbons
date j.Iow P by Iy Z_Zr Gas Piping date b
Foundation Walls date by Set Up
date d3 zZ 9 by INSULATION date by
BG/SLAB InklatioK 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, ' ' t
date by ,�- j—�r 1V by , — date by
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\� Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION ok 6
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/11-8Q,Q-5-562-5628 1P
PLEASE PRINT � i
#1 Owner Krw Phone# 4.2-7 I
Site Address r 4 IQ c, {�A re District# AD
City n h 1 tL�i St Zip 98sd4
Directions to Job Site :1,tr N Le-P-t- o N f o 1 al s4-cL tr C orrcc+;aria
IoZ. t ay t traa #-C/love gbMo S+raiaGr+�LAD * Cuj De Sac.
r~~ftr; j 5 Lo+ i o u rA L e-P4
Owner Mailing Address p0 Oo& I6o g
City sill-, +C St W& Zip gsssq
Lien/Title Holder Qc,�V#�,I-
Address t o A \ Z-
Clty St �Zip
#2 Contractor Name 14 csekj ef it ra Contractor Reg# Cty)8-R. 1P&OL4��.
Address 1 v�( 14y Expiration Date 0% / /q / g 5
City At-cz�vA St _Zip Ct 6,44 Phone# S*5 7 Rq ER
#3 If septic is located on project site, include records.
Connect to Septic?'K-Public Water Supply_ Well
Connect to Sewer System?_�Name of System nid�-ILL ,_ C i 1
(If residential, proof of potable water is required)
#4 Parcel No. _-_ -7 -90 i U
Legal Description
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
C Basement / Deck / #bedrooms #bathrooms /
Garage 40 / 3(� • Carport / (Circle:Attached o Det a ?) i
Other Zc� sq.ft. /
#6 Use of building —Describe work
#7 Type of Job: New _Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year ci Make -,-*-,Model S RC h'►,�-n�K ��v
Length '76 Widths Serial No. (9 16\
# Bedrooms #Bathrooms Type of Heat c.
Purchase Price $ Gb "eJ*
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property: /V
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan �4
Lot Dimensions Flood Zones
Existing Structures Fences t
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements z
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
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
y r
Plumbing Fixtures ($3 eachj Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
4` —Bath Basins 11 Heatpump, Other
—Bath Tubs l No. Units Fees
Showers Furn BTU
Hot Water Htr — Heatpumps
Laundry Washer — Vent Systems
—Sinks — Spot Vent Fans
Floor Drains Boilers/Compressors
—Laundry Basins HP
Dishwasher No. Air Handling Units
—Disposal ' — cfm#
Urinals No. re Pr i n t ms
Other Auto, Fire Alarm Sys 50.00
Fixed\F re 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
I. MEANS OF A PROGRESS INSPECTION.
E
i
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. DEPARTM
X OWNER X BY r
DATE DATE
FOR OFFICIAL USE L�NLY,Accepted by, Date a ,
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review fv\H L-4 N DyV&-S 01 L sects e0 ST �+o G1x-SS A
Occupancy Group:!Z is
►'►�' ype of Const: 511J
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit �� GO _ASLA —
Plan Check U
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE v
--- - -
DEPARTMENT OF LABOR AND INDUSTRIES
THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A
� L
REGISTRATION NUMBER' EXPIRATION DATE
w P'�`�' r' STATE OF WASHINGTON
C . NT4A L POK GEN CON TRLAC-in S
P O:BJX 44191 .,
TAC04A WA 98444
F625-052-000(3 92)J'
T _ nIRPL
MASON COUNTY r
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(206) 427-9670
CORRECTION NOTICE
Job Location
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: � 'p
Items listed bel w must be corrected to gain code compliance
Z4�lz z�/�
You are hereby notified that the above corrections shall be made BEFORE
PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OKto
Department
--'/Date Inspector
DO 14 REMOVE HIS TAG
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