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Home My WebLink AboutBLD94-1019 Cancelled Mobile Home and Deck #39 - BLD Permit / Conditions - 1/27/1999 MASON COUNTY PERMIT ' Mason County Bldg. III 426 W. Cedar NULL & VOID BMP2 IRATION P.O. Box 186 Shelton, Washington 98584 SATE l�-ice eY oa . .......... .._.. ............ :•'.;Ui`; iL I Allk .GNU I UNNALL s� ;!Hol- }... t .p! r• 1 „ itt,: is ! , CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls _date by Set Lip date by INSULATION date by BGISLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date b 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 i a „ �:- �L. MASON COUNTY Mason County Bldg, Ill 426 W, Cedar P.O, Box 186 Shelton, Washington 98584 A � Permit No. a WNWILDING MASON COUNTY�� _ s PERMIT APPLICATION qu 4U 1q 46 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800- 62-5628 PLEASE/PRINT �-�1 Phone#Site Address (a.,1 1 .- - L Fire District# <� City .. St Zip____. Directions to Job Site +J �. j S Cc7 U \Gc< „-) Owner Mailing Address City St Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project site, include record . Connect to Septic? P blic Water Supply Well Connect to Sewer System? Name of SystemI(Ap� ( �'�L � k (If residential, proof of potable water is required) #4 Parcel No. i _ -' - Fi _ 6r Legal Description f' -k f,., ,. : - 1 #5 Building Square Footage: (existing/proposed) 1st FI 2nd FI ---y" 3rd FIB—�`%-.. . Loft Basement / Deck #bedrooms / #bathrooms / Garage --t Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building -.. Describe work CoN� i #7 Type of Job: New Add Alt Repair Other 1#8 MOBILE/MANUFACTURED HOME INFORMATION Model Year 6�7 Make KA ,�,-y,r, odel Length_ Ly Width !tj Serial No. { , # Bedrooms 1 # Bathrooms___I_Type of Heat Purchase Price 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 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 DRAWSiTE PLAN BELOW 1 t i ` i i 7t.1.t•_ • i , APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fix era_ arhl EP& Mechanical Fixtures ($6 aachk No.yToilets CIRCLE FUEL TYPE: Gas, Electric, —Bath Basins Heatpump, Other ,Bath,Tubs Nam., ni � Fees —Showers _ Furn B . i —Hot Water Htr . Heatpumps ____Laundry Washer Vent�Sy ms —Sinks _ �t"Vent Fans —Floor Drains Nam,,�Qoilers/Qom r ors —Laundry Basins HP _Dishwasher /% •No. Air Handling nits `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 A*Fire Sprink Sys 25.00 TOTAL PL IfNG $_ Imo. Other\ Gas Outlets Wood, Gas, Pellet St e 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 APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. K OWNER �� 'Y X BY SATE 4,1 DATE OR OFFICIAL USE ONLY:Accepted by: ��L Date DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold j Approval Planning: 5 r We�� A`t --- Environmental Health: F Z- , Building Plan Review i 1 Occupancy Group: Type of Const: Fire Marshal: ' Other: FEES Special Conditions: Mag,� ~ Building Permit ��i /�,."� K Plan Check / C C> Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee 'f• `1 Other Other _ t/ Zwldina�Valuafi`on7�- —_ ____ TOTAL FEE 13S Golden Rell Mobile Home Park NE 20 Roexcel Rd. Beifair, WA 98528 Phone(206) 275-4623 Ueede Schattenkerk, Rlallager MASON COUNTY Mason County Bldg, 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 PERMIT NULL & VOID Ulf�E, XP%RATION D AT E ZZ BY �lN r CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping _ date b Foundation Walls date by Set Up date by INSULATION date Lj—�(/by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING l OTHER Groundwork Attic '�" date b date by �`�' WALLBOARD NAILING lD_ Y D.W.V. date by date by Water Line FINAL INSPECTION date by date by date by IESIQENTIAL GAS APPUANCE SYSTEM CHECK GA�i UfUC.. GAS CFECK- account Number Comparry/Locationl — lame 1n1 rC UrYt `' �} Dante 0 !3'�T Requested Iddress yN]� � l o 1`0 Q 55 eqL n"t �• Name r m PC /Je 4 t�/ W)+ ` Z Instructions elephone: Office Home Performance Check: Item Central Heating 1 Space heater 2 Water Heater 3 Range 4 Clothes Dryer 5 6 7 Manufacturer &L-m194) N! G tt- (� f Model No. -11q (1- LA-7 Serial No. 01A51 Ig4iUI fv 1 2-2? Fuel L-P Manual Shutoff(Installed/Existing) ✓ r' i Sediment Trap (installed/Existing) c/ Control Mfgr/Model No. ✓ `` ✓ f Pilots)/Pilot Safety System Ignition System(s) Mfgr./Model No. Thermostats MfgrlModel No. v Bumer(s)/Combustion Chamber Venting System/Draft Diverter ✓ Combustion Air Red Tag Removed from Service)/Recall TANK/CYLINDER (Additional Serial No.'s): SIZE SERIAL NUMBER MFR. MFR.DATE LAST LOCA' TANK PAINT PIGTAIL FITTINGS GUAGE RELIEF VALVE FITTINGS TEST DATE TION COND. COND. CONO. COND. COND. COND. DATE CAP EAK TEST PIPING/REGULATOR OPERATION/CONDITION PIPING REGULATOR REGULATOR REG.VENT HOW FLAW LOCK UP i SINGLE IAL SIZ MF DATE COD MFR. CONDITION MODEL POSITION PROTECTED PRESSURE PRESSURE MAT STAGE T� 3 y,. /ZoLd Ne'J OtJn Ltd 12 IN we 12.jdN vac TWO L2, PSIG PSIG STAGE IN WC IN'NC SYSTEM LEAK TEST �^ L SINGLE STAGE/ START PRESSURE END PRESSURE TIME HELD SYSTEM OK Comments: Jar Tu M — con ripG7— M 23ziSTl v+L SECOND STAGE (INCHES NC) (INCHES IA>r) s SAS jTE � G� 4 4o✓ IlZ aka , A ct�t.i? FoyN DUll This inspection covers(propane&P-gas)items and equipment visible and accessible to the service technician and represents the conditions existing on the date of inspection, tt does not cover latent or manufacturing defects,the internal working of sealed equipment,or structural components,and cannot be construed to cover future or unforseen happenings. Reference Invoice No. Date I, �01Y �G� 1 � G'm Print) (Please /3YUCQ yQ • (Please Print) Know how to turn off gas in case of emergency. •Have smelled propane and can detect its odor. Certify that I have completed the System Check as prescribed •Have received the Consumer Safety information and material. Performed Odor Test .,XYes Performed Leak Test -tlf Yes •Had gas system deficiencies and/or corrections,if ally,clearly explained to me. •Am satisfied with the service wo rformed. Placed Safety Decal G Yes Left Consumer Safety Into and Material Yes M mi—T.hn—n'<ein tur•l