HomeMy WebLinkAboutBLD94-1563 Mobile Home #15 - BLD Permit / Conditions - 2/3/1995 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL [Ribbons
OBILE HOME
Footings-Setback date by
date by Gas Piping date 6
Foundation Walls date b Set Up
date by INSULATION date by
BGISLAB Insulation Floors Final
date
FRAMING by
date by date by
Walls
FIRE DEPT.
date by
date by date by
PLUMBING ---------------
Groundwork Attic OTHER
date b date by
0 W WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
I
MASON COUNTY
!.!• Mason County Bldg, IIi 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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tASON
C$a„c Permit No.
COUNTY /l �'
BUILDING PERMIT APPLICATION �°�
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 er 7S I Cc tq 1 Phone#
ite Address _. Z cy mac. \ " - Fire District# �-
City St Zip
Directions to Job Site
Owner Mailing Address rv�E_
City St Zip
Lien/Title Holder CCU Q g:"T €-E--
Address t_
Clty St Zip
#2 Contractor Name . Contractor Reg #
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System �>,L A rl
(If, residential, oof of potable water is required)
0.
0 L gal Description i,` 1 Ltd 4 v .k
#5 Building Square Footage: (existing/proposed) '.
1st FI / 2nd FI / 3rd FI / Loft /
Basement / --Deck-, / # bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building �_ i V`l r�_� Describe work
#7 Type of Job: New—,/—Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year "1�Make Model x L-- `
Length 4 1<5 Width_Z le - Serial No. I Dry Z A� �S
# Bedrooms ? # Bathrooms 2-- Type of Heat (c.e F-C`t O-L- .
Purchase Price$ il<C)
#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 ti`
Show following on the site plan
Lot Dimensions Flood Zones �P
Existing Structures '� Fences
Structure Setbacks Driveways c
Water Lines Y Shorelines J�
Drainage Plan r! Topography 4
Septic Systems ° �_ Wells --" L"
Proposed Improvements t%sements Indicate Directional b N, S, E, W
Name of Flanking Street L-_-- y )
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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l .3
C-lJYt/\ YVL2 J`\. L A-A
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
0
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. QEjMFees
Shower Furn BTU
Ho ater Htr Heatpumps
aundry Washer Vent System
Sinks Spot V t Fans
Floor Drains No. B ' rs/ComDresam
_Laundry Basins _ HP
Dishwasher No. Air Handling_Units
_Disposal cfm#
Urinals 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
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 OB AINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEP T. DEPARTMENT.
X OWNER C->Ay - X BY
DATE DATE
FOR OFI'ICIAL'USE ONLY:Accepted by: -� Date: O 1`3
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:: n'lob�l� } 1Cucrn
�Y,a c ins x)d� C,5 r? C04 b l ` (�r vi r,,A r r ' r+'IS
T
6ru�rlin /' -t -�l11SL-
Environmental Health:
Building Plan Review
&A
Occupancy Group:k-3 Type of Const: -
Fire Marshal:
Other: +
I
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee S/ S
Other
Other
Building Valuation: TOTAL FEE