HomeMy WebLinkAboutBLD93-0855 Mobile Home - BLD Permit / Conditions - 6/16/1993 r
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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APPROVED pE:4Rt buil.911116 (AN of ilttAPHO,
Poll - 70
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date �p N 3 b l,91
Fpundation Walls date by Set Up
date by INSULATION date elm 3 by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic ,Q
date by
date b
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date< ' by date by
l — —l7Zct5 /7Q-
21� OF 8 V E Permit No.
MASON COUNTY —1_
�� i 9 '9�� BUILDING PERMIT APPLICATION A
GENERAL SERVICt2g W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner -fcy,7e2` .T .f yd Aran / A��V >ono/ Phone # L1,�7 t,'
Site Address—,,--- t-/0 —Fire District# 5�
City S'h el te,►7 �(.t�J,J.,4��S,�i St limit , Zip
Directions to Job Site d�I�" To -, -f-r Ri4,� .sue A 7—Ze
Eft ff4�4 f C S f0 S 7`0 S /O r� TU Pr7 / ` an !ft 0!�/PO X• /l2 L/�S ?`O
y�2fI8 wigJY ie011 7-aA9rl 4 e 3-�7- ° 'top Zee 4/��/ n / /oC TUR/1 rf f 4ii DC
flkn �eigjf aa h o1: �a on iP `
Owner Mai fng Address_ a 19 0 %oA 7 e c�
City S'h F/7`o a aJl>- S A/ St 4"% _5'k Zip �o�rY`/
Lien/Title Holder � �,ee f! J r9�n h� ,9.�inorr�
Address E a 2
City fi-e /7�a 7 d St& Aj Zip <i�3��Z
#2 Contractor Name _ I1�fIn a Y'�c Tau R I,d /-/o rn e Contractor Reg #
Address T Expiration Date
City St Zip Phone #
#3 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. O ? - .f h
Legal Description 4, r/yY 9 � t o,E S X -ldifl'oll
�/o/&A# -i- o F P/.5,rs, ram% t F3 'C"ec'fds o f "W'3LI Cuanf��CvX�S� ii1�f0/!
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#5 Building Square Footage: (existing/proposed)
1 st FI l/°10 / 2nd FI / 3rd FI / Loft /
Basement / Deck / # bedrooms 7 / # bathrooms _/
Garage / Carport 7 (Circle Attache or Detached?)
Other sq. ft. /
#6 Use of building Describe work
#7 Type of Job: New X Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year / �Fi_5_Make/,;b�Model i.bp,� fore
Length y0 Widths_Serial No. i7Nz�yyC
# BedroomsJ'# Bathrooms _Type of Heat A 1ec,,4.Qi r
Purchase Price $ 3g, oco, d o
#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 j
Structure Setbacks Driveways i
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
S
i I
I �
°,4 F� s
sr
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
r /
P in Fixtures h Fee Mechanical Fixtures ($6 each).
No. Toi s CIRCLE FUEL TYPE: Gas, Electric,
Bath Ba ' s Heatpump, Other
_Bath Tubs No. Uaija F
_Showers — Furn BTU
—Hot Water Htr — Heatpumps
I _Laundry Washer _ Vent Syste
Sinks _ S ent Fans
_Floor Drains Boilers/Compressors
—Laundry Basins — HP
Dishwasher No. Air Handling Units
_Disposal _ cfm#
Urinals No. Fire Protection Systems
Other Auto. Fire Alarm Sys 50.00
ixed Fire Supp. Sys 50.00
P it Basic Fee .15.00 _ Au Fire Sprink Sys 25.00
TOTAL PLUMBING $ No. Other
Gas Outlets
Wood, Gas, Pelle tove
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 .00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
'j;_CWNERS 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. DEPARTMENT.
X OWNER X BY
DATE — 5—q "3 G� DATE
FOR OFFICIAL USE ONLY: Accepted by: ,Date._ - y"
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health: PA./ S c :eejits
Mi
Building Plan Review Q O
S [.�
Occupancy Group: Type of Const:
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
r Road No: 22330
Road Name: Ashwood Lane
MASON COUNTY ROAD DEPARTMENT
411 North Fifth
Shelton, WA 98584
PERMIT
Subject to all terms, conditions and provisions written or printed below or on
any part of this form,
PERMISSION IS HEREBY GRANTED TO: Kenneth J. Raymond
Address: E. 2290 Agate Road, Shelton, WA 98584 Phone: 426-8762
To install a single family access
Location: Approximately four lots down on right-hand side. (Address is E.
40 Ashwood Lane, but does not have a mailbox yet. )
Legal Description: Lot 14, Block 2, Plat of Shorecrest Terrace 2nd Add.
Volume 5 of Plats, Page 83, records of Mason County
REMARKS:
Culvert Specifications: Culvert to be metal, concrete or polyethylene.
Culvert to be minimum of 12" diameter by 20' length.
Culvert will lay in fine of ditch.
Access to be graveled to property line with 3" of clean gravel.
A Bond in the amount of $ 25.00 accompanies this permit.
(Rct. # 13020 Check # CASH . )
n
Contractor: Address: ^r Phone:
License No: Expires:
* Access w01 be staked and flagged by Permittee for pre-inspection.
* Access 011 be pre-inspected by this office prior to installation.
* Access installation shall be in accordance with county specifications.
* Commercial/multi use access shall require STOP sign, installed in
conformance to the MUTCD manual, at intersection with county road.
No work shall be done under this permit until the party or parties to whom it
is granted shall have communicated with, and received instructions from the
Road Supervisor , Phone: 427-9670 extension 450.
This permit shall be void unless the work herein contemplated shall have been
completed on or before 19
DATED at Shelton, Washington, this day of 19
Issued by:
Title: