HomeMy WebLinkAboutBLD93-0838 Cancelled Add On - BLD Permit / Conditions - 11/2/1999 MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
oi"te by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date 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
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
diite by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date 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
date by date by
D.W.V. WALLBOARD NAILING
date by
date by
Water Line FINAL INSPECTION
date by date by date by
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M Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 O
LEASE PRINT
1 Owner l e5 !,dec, X1, _Phone# -;�O(v S-71v - S'�(c a d, 89b-22 DCv
Site Address N r ;1.8'a y b e��a:r l�a s 1�w4 y Fire District#�_
City &C/�'-r St Zip
Directions to Job Site ► h[.1 Nor4-k 125� $e_«a r b^ C-1 K
Owner Mailing Address 1.;�7 3!r _ .e u&T,-,J. L.n.
City porgy Or N- . )o".sl,. St wA Zip
Lien/Title Holder C 9
Address
Clty St Zip 1
Contractor Name L.eS Contractor Reg#
Address c�3 S '� do Ln . Expiration Date
City POLT l'�cc _o. __St_ _Zip Q 93(aLv Phone# :.,06-5r9Co 4/4? a
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)
Parcel NoA D-I-DD l �^- a S - DD 016
Legal Description S '/-, c fi S V:I v� S W yy o�- 10 w /yam0 3 F- R
Building Square (existing/proposed) ;�,k,l a89v"5'
1st FI c (eO 3d nd FI / 3rd FI / Loft /
Basement / Deck /3`I.)t5�=� #bedrooms J / #bathrooms / 3
Garage / Carport / (Circle:Attached or Detached?) S
Other sq.ft.
#6 Use of building �-��/���o Describe work `cL o n
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Lenwrom
Width Serial No.
# B # Bathrooms Type of Heat
Purchase Price $
i#9 I to 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
J
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p£1 - •J,dC Y _
0.7NYd� V , 1� t
1 /� F
' I 1 • 54 F
k
APPROVED
MASON BUILKNG INSPUTOR
H GES SUIRCT T, APPROVAL
DATE.
Show following -.)n 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
�ya0r V
i
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
I
Plumbing Fixturees ($3 each) F Mechanical Fixtures ($6 each)
G,1\�
No. aToilets CIR FUEL TYPE: Gas, Electric,
ABath Basins Heatpump, Other
Bath Tubs No. UnitsFees
l Showers Furn BTU
_Hot Water Htr Heatpumps
_Laundry Washer , Vent Systems �-
Sinks T Spot Vent Fans
Floor Drains Nam. Boilers/Compressors
_Laundry Basins HP
Dishwasher No.. Air Handling Units
I 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 $ . Other
Gas Outlets
�J v 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 OFTHE 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 DEP,�RTM T DEPARTMENT.
X OWNER / X BY
DATE 4 ( �`�3 DATE
I
FOR OFFICIAL USE ONLY: Accepted by: F. _` ` Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health: t�`�S 5-f. T�L P-eg yti.n60
`�
I
i
Building Plan Review
Occupancy Group: Type of Const:
Fire Marshal:
Other:
FEES
Special Conditions:
Building Permit OS. db
Plan Check 5
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee q,50
Other
Other
Building Valuation: TOTAL FEE y, J