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HomeMy WebLinkAboutBLD94-0312 MFG Home - BLD Application - 3/31/1994 Permit No. z � L L MASON COUNTY MAC? 3311 1994 BUILDING PERMIT APPLICATION FFQQII TT SERVICE 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEAS'FA K1 #1 Owner F4 O r P 1-�7. S i /-YL J A d �;4 2l Phone# a o 6 - 'r/-D S Site Tress i" ';ZD/e -/ 3 - DOD 60 Fire District# /3, / City St Zip Direction o Job Site 0m Owner Mailing Address CityzJz e�--Zz � St Zip 8'3/ Lien/Title Holder Address City St Zip l Contractor Name e. Contractor Reg# Address Expiration Date City St Zip Phone# � ,1W If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 Parcel No. - 43 - 0 666Z) Legal Descriptions 990 E`2 i,vyZ 5 Ld A)E E X TK #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / Use of building P\QZ'1CJ0 f\t A Describe work Type of Job: New_r/ Add Alt Repair Other #8 MOBILE/MANUF CTURED OME INFORMATION Model Yea O Mak Model 2 Length Width Serial No. ` # Bedrooms _# Bathrooms Type of Heat G� Purchase Price $ r :: 4bA 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 i-�c 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 Steve-}ire, grope I 1 i nes e-1� Kil PPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW PlumWAtures ($3 each) Fee Mechanical Fixtures ($6 each) Am— No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. Units Fees Showers Furn BTU _Hot Water Htr Heatpumps _Laundry Washer Vent Sy ms _Sinks _ Sp ent 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 OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ 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 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 eAPPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNE 7 `� X BY DATE 3 c� T DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: n_ I Environmental Health: Building Plan Review '1 1 H 94 n+©tN 6 S. M��ec-s , 120 sT 0 j/tC:S Occupancy Group: -3 Type of Const: c�-N Fire Marshal: Other: Special Conditions: FEES Building Permit ' 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 MASON COUNTY TREASURER 1994 MASON COUNTY RGE TWP SEC DORENE RAE REAL PROPERTY P.O.BOX 429 TAX STATEMENT � �> SHELTON,WA 98584-0429 1 0:1.0 13 00060 REAL PRQKRT YOE SCRo LAND A.V. IMPRA.V. TOTAL A.V. 700 F::k T fF 1F.P.ACREAGE LEVY 0.1.4r TAXING DISTRICTS GROSS TAX SR.CITIZENS EXEMPTION ASSESSMENTS 1994 NET TAX �—�: D LOCAL SCHOOL DIST. PORT DIST. y FIRE DIST. EMERGENCY MED. FIRE PATROL LIBRARY STATE SCHOOL COUNTY HOSPITAL OTHER FIRE BENEFIT 6 6.1 -r T'S ,.. c y i :1 s ASSESSMENTS DELINQUENT PAYMENTS RECEIVED WITHOUT INTEREST AND PENALTY WILL BE RETURNED YOUR CANCELLED CHECK IS YOUR RECEIPT DELINQUENT TAX INFORMATION INTEREST YR. DELINQUENT TAX ASSESSMENTS 6 PENALTY TOTAL F�•I...(:)l''l:l A wi'f.i�7l.Jt�lI:12at"".}� ti:l:lvil.l(?<��0C3 N ) EsOX 3.241. 92 91. 90 LOAN (39 TITLE OWNER NUMBER TAXES DELINQUENT AFTER APRIL 30 UNLESS 1ST HALF PAID. INTEREST AND PENALTY CHARGED ON • r DELINQUENT TAXES. 2ND HALF TAXES DELINQUENT AFTER OCT.31. •• • • • • ST/\[E (]FVVASHUNGTON DEPARTMENT D�������� �v6L61 u�u-����� n /vuu_»� n ��x x_uv~x_:�~�u/ ��� ULHlCLE TITLE CERTIFICATE 2�/94 I8S�E-��TE TAB-NO RE E V. VALUE-CODE/YR DEPRE MU-REC M8-GWT �966 1 00/30/011 15500 94 ^U�Lk U, ITJD-YR MHKE SERlES/BUDf YI O SEKI L-NO RES-CO INC/UNINC MUb 80 V. Kk8250 18 U �LAT� �� � ��T -EX� P PRE�.-PLT PREV-ll | L��NO Sl 1 9073434014 WA COMME||T : nILE IL;L � � RE6I ED OWNER LE-GAL OWNER �IMUN3SU� , FLOfD A P O BOX 1241 RO A �10BRErE 8 I iLkTI[Y THAT THE INFORMATIOH C MTAIHE� HEREON IS ACCURATE MAD CO;!PLETE . X 5l�HH � i�<L DF k�613 ! LX�D O�N[R ( S ) SIGNATURE OF RECISTER�D OWNE� ( S � G DAY OF V 19.............. - FlLl i G 3 . 00 EXClSE T X A CHECK 1274 . 75 SUt-! L;ENT DT IRI 16 . 25 CASH � ze LOCAL JPTIUN USE T 5 . 50 TOTAL FEES 1274 . 75 VHL1L'QT}U f- Q,9E 0UIU01U194Q, U0 9g4 0Z401604b 7Rn�SF �R 5101"E 01' WAL-4HtNGv,.)M TlTLE APPLICATlON/RA.QISlHATION U.1-0IF1CATE K" | iU : A ITi`X-1 THIS DUCUMENT Ill, NJT PKOUF OF O�h'�NSHIP w��� CUSTOMER'S COPY