HomeMy WebLinkAboutMIS93-00198 Cancelled Mobile Storage #38 - MIS Application - 10/16/1997 Permit No! � l�93"�1�.
� MASON COUNTY
BUILDING PERMIT APPLICATION �i� 1
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427- -800-562-5 8
PLEASE PRINT �
#1 Owner _ hone
P c
Site Address
Fire District#
City /mac=1 L St 5 N Zip
Directions to Job Site
Owner Mailing Address i — .S'A
City -St-zip-
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name f
U Contractor Reg#�o�YQ�7
Address t rr�ohn Expiration Date
City St Zip Phone#
43 If septic is located o roject site, include records.\
Connect to Septic? Public Water Supply Y Well
Connect to Sewer System? Name of System t-A-z jTTa
(If residential, proof of potable water is required)
#4 Parcel Not) 3 3
Legal Description
#5 Building Square Footage: (existing/proposed)
1 st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other Ci !!5� . sq. ft. /
#6 Use of building k Describe work : f
�7 Type of Job: New—IX74 Add Alt Repair Other
W8 MOBILE/MANUFACTURED HOME INFORMATION
Model Yew' sK.Make Model—��
Length 515' kdth Jt+O Serial No. S
# Bedrooms #Bathrooms_Type of Heat r
Purchase Priceopp-l—e
f9 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
Structure Setbacks Driveways
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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
P—lumtina Fix Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
:Bath Basins Heatpump, Other
Bath Tubs No. Un Fees
\ Nwers Furn BTU
_Hot Wa Htr _ _ Heatpumps
_Laundry Was _ Vent Systems
__Sinks Spot Vent Fans
_Floor Drains NQ Boilers/Comraressors
—Laundry Basins HP
__Dishwasher N� Air Handling Units
,Disposal _ cfm#_
---Urinals
� �� L� Fire Protection �v t ms
Other_- Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Per /Basicee 15.00 A Fire Sprink Sys 25.00
j TOTAL PLUMBING $ j Other
Gas Outlets
Wood, Gas, Pellet ove
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 1N 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 0 W N E R /(� ���, X BY
DATE �� DATE
Y -�....
FOR OFFICIAL USE ONLY:Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: �:-\IAgA fy)1)ttytil(�,� �� S��1xiGYlC VMS
Environmental Health:
Building Plan Review
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
s Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE