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Home My WebLink AboutBLD95-01195 Cancelled Mobile Home - BLD Application - 2/5/1999 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 Q r� p #1 U I rn� 1\. 2�M R Y1S Phone # «fo� 7 /' 0 by 1 A r s 0 �� /L (�A Fire District# I- City I S�t�WR Zip (485 Di r ctio s to Job ite 1'1r1 I UY1 �E';-' 5,1 f- Own Mailing Address 39 06 rf-nmdv O Or— City St Wff Zip q 831� Lien/Title Holder I yn S Addr s WI6 vE- City r(iYYI St (A) _Zip 8 � #2 Contractor Name VI'CtS &U A'U+4 '\ Contractor Reg 41esQL-�- g5c.L Addre s CL n eV- Expiration Date 03 /—_/ 95 City � St U)R Zip Phone#C,Ic(o) 377-6qz-g #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 cel No. 10 - .50 Legal Description c-1tol=f t K AC+ #5 Building Souare FoOtage:^(existing/proposed) t 1 st FI_ _ B 4 2�nd FI Ylr 3rd FI Y11Pr / Loft 'A I A E51 Basement 1A / Deck n/A / # bedrooms /aas © #bathrooms / ?� Garage / aS�Carport n A / (Circle: Attached o Detached? Other sq. ft. A / #6 Use of building Ids l V'f ji-ofn F— Describe work �T�LLA-- tCrl, o "tu L-_- h trnE #7 Type of Job: New _Add Alt Repair Other Y1'lc &LL #8 MOBILE/MANUFACTURED HOME INFORMATION �j.` Model Year `mil Make I (Zmv7 - Model f1�� Length QO Width i y F�al No. nE S # Bedrooms o2, # Bathrooms Type of Heat RO PMF— aUG Purchase Price $ 1 j�000, 00 l #9 I i to by circling the applicable source if any water is on or adjacent to subject propet•tTH SERVICES 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 `v APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures*($3 eachl Fee Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas Electric, _Bath Basins Heatpump, Other o q h ' Bath Tubs No.. QDjLa Fees Showers Furn YG 00 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 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 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 APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT X OWNER X BY DATE 1z �l �� DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: 5 S 1 %gm Lod ice, - "6`!a Aq C Environmental Health: Building Plan Review Occupancy Group: r Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit QUO— Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other r-. Other Building Valuation: TOTAL FEE �, )