HomeMy WebLinkAboutBLD99-1023 REPAIR - BLD Permit / Conditions - 12/23/1999 no rrl
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
j date by Gas Piping date by
I 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. WALL O RD NAILING
date by date 24-2.6W by
Water Line FINAL INSPECTION
date by date date by
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. Agar � .
NO.: BLD 0407-3
MASON COUNTY
BUILDING PERMIT APPLICATION o'��
426 W.Cedar/P.O.Box 186,Shelton,WA 98584 g
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION zz (ZCA-AY
Owner TcqWS.Q!54C 4 Contractor Name 1,04yt MOIX AG- S
Mailing Address i, Mailing Address
City y-,t I i(r+,. State i,,)A Zip Code ftt t,, City ';y ht itv.. State tA)Y-1 Zip Code `S'�"` •
Phone( 36) qs6 % . Other Ph.(. q32 1�: Ph.( 'b-D 41 �69Other Ph.(
Lien/Title Holder WA. m •.,oI Contractor Reg. #
Address ulmoil, Expiration
[SETIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
em Name of Sewer System Well Water System Name of
er System
PARCEL INFORMATION-12 digit Tax Parcel No. / / Fire District
Legal Description
Site Address(Please include street name, street number and city)
Directions to site
9:
Will timber be cut and sold in parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water (Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work 1CI4'rn.' itivcf
No. of Bedrooms,,N _No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other &16 sq. ft.
GaraLe Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make_ Model Model Year
Length Width Serial,No. ,. No.. of Bedrooms No. of Bathrooms
Type of Heat Purchase r'k $ Replacement Unit ?(Yes/No)
Installer Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
X Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
D R�RTI1IIi NTAI» REVIEW APPROV D ENIIwp CONDITION-CODES:
Building Department
Occ Group 0-rype Construe'
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
FhE$
_. . ..
Building Permit Fee u 7 Site Inspection
Plan Review Fee l 4 UFC Plan Review Fee
r
Plumbing & Base Fee Public Works Review Fee
Mechanical & Base Fee Other'\5%
Wood/Gas/Pellet Stove Fee Other
Violation Fee Pre-Paid at Submittal ( )
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