The URL can be used to link to this page

Home My WebLink AboutBLD97-1119 Mobile Home # 401 - BLD Application - 9/22/1997I 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 #1 Owner Gl� S , C Y,I Phone# Site Address A(c S , Fire District# City " St zip Directions to Job Site Saff ` 5 Owner Mailing Address 104 /$9 City 66W C LAIA S� St WX Zip Lien/Title Holder G LAB evi2P- Address •d•&6X 3 0 Clty 2 11-> St Zip Sa9�T�1/ #2 Contractor Name S vi S Contractor Reg#AL�I f� Address 40 S9 Expiration Date �K / -44 /99 City c /Z St Zip `185�Z Phone#1 3 e0-754 D7 92 'A W:4 inlFj SD 2 BO #3 If septic is located on p ject sit includ re rd . Connect to Septic? Public ter ply Well Connect to Sewer System? Na yste (If residential, proof of potable water is require ) ✓��'�e� l�'lo�ji�� ES' S U� er5�err, #4 Parcel No.#'LO0 - 33 - Q-20-4-10- Legal Description S 3 S� Ev � S ld1 (Enreonn�/'7ob le tC5'4��5 #5 Building Square Footage: (existing/proposed) 1st FI 207 / 2nd FI / 3rd FI / Loft / Basement / Deck(F,-?rvP- / K-+ #bedrooms Z / #bathrooms Z- / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building 5-/-57/1- Describe work #7 Type of Job: New v Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Makes,/Ag9, Model Length Zr Width Serial No.7 7, # Bedrooms # Bathrooms2 `Z-- Type of Heat Purchase Price$ •3 3��9 #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: xfi1-2-. 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 4 � .c�V s3 fN'G o r° ► � / irk Par er � /' NtlC t h `I t* S � i APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.25 eachl Fee Mechanical Fixtures ($6.50 each No. Tolets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Units 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 16.25 Auto Fire Sprink Sys 35.00 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 16.25 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 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 OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORKFOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL)3E IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO ANGESALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST AIN /APP AL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPA EN �/ n X OWNER X B i DATE DATA .2 97 FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY C Approved Coed.. Hold �n Approval Planning: LC4 Environmental Health: Building Plan Review &M i%Z� Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit l� Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other_ Building Valuation: TOTAL FEE cj '� MASON COUNTY PERMIT ASSISTANCE CENTER P.O. Box 186 Shelton, e ton, WA 98584 NOTIFICATION OF PERMIT CANCELLATION Date: 01/22/99 JACK ST. CYR P.O. BOX 1896 OCEAN CITY WA 98569 Permit Number: BLD97-1119 Parcel Number: 420013300040 Project Description: MOBILE HOME Upon review of our records, the Mason County Permit Assistance Center has identified that your building permit was ready to issue on 09/15/97 . Permits are valid for 6 months once approved and at this time we are attempting to clear all unclaimed permits . If you intend to obtain this permit, you must make arrangements to do so within ten working days from the date of this letter. If we do not hear from you within ten days, we will cancel your permit and make arrangements for a building inspector to do a site visit . In the event that your project has been completed and a permit was never issued, you will be assessed penalties as allowed under Mason County Ordinance 37-96 . If your project has been cancelled or if you intend to withdraw the permit, a plan review fee will be due for work that the Permit Assistance Center has already performed during the processing of your permit application. This fee is assessed pursuant to Section 107 of the Uniform Building Code. In addition, a parcel flag will be attached to your property until the fee has been paid. Please be advised that this parcel flag could prohibit future development or improvement of your property. Please call (360) 427-9670, ext. 354 to resolve this matter or if you believe you have received this notice in error. Thank you for your cooperation. Sincerely, Fee Amount Due Kathy Soi e, Clerical Assistant Mason County Permit Assistance Center PENDEXPR, rev: 01/15/99 c r J AQ - rig 4 ----- ------ ---_ ---- low �o I -- -----— -- tip- 4 d AS--- i 5'to'99 � �_. 'i# � , • ` �► �� f - � I- , =�T Y i ' ��