HomeMy WebLinkAboutBLD93-0609 Mobile Home - BLD Permit / Conditions - 9/5/1995 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O, Box 186 Shelton, Washington 98584
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AP V OVER ptfllRf 8U110 N4 CAN Of ACCOPIF}+. •
OWNER UR AhtNl CGS a � - bhlF 7— Z—.
Ill_►1N1 , rev: 13131j9! C:G"PIt IANCE 10 AI 1ACHU0 CON01 I iOl1'j l;i RLQUIRE•Ii
CONCRETE MECHANICAL _ MOBILE HOME
Footings-Setback date •by Ribbons
date by Gas Piping date
Foundation Walls date by Set Up
d to by INSULATION date by
BG/SLAB Insulation Floors Final
date FRAMING by date. by date by
Walls FIRE DEPT.
date PLUMBING by date by date by
Attic OTHER
Groundwork date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
C/_ 5— �; 5— L
lac r n y J� n
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WA ,
,Q . S.acres i cewl .
V
the
IIZaS01 couniy
2
.. assessor
Des c
t
QQ have rcuncly received a eogy of C= eertifieaca for: ewb£la home
aovemanc on your mobLla kome_
In order Chac ve ma l l
y'accurace y rsua you oobile ltoaa, please coaPlece
the qucscions below and recurs chic fac= to our office bp'
Ic is imPeracive that cabs Wocmation be prov3�ad_oo grewac s
possible double asses meat. — .
MDE=—%* HCht DATA Lp= /,, C, q
M=U`
o
MCIS= HIE Laeui=x aiTcr2xa.=cm
/►_ •ft prtvacely, a..+sed Land_ . 80
E It csnced or teased Land who lros_' VAHM
aDa s Ali I7�- :7/f csr & era=
e_ RaL Prfl¢ecdy ?a mei I (caz stacs.ac #) ?/ OZOGB
a hasLLog a:se and address for o.. c of eimhLla home
(,{/
E. Laeacian address of arobile
Jr. Dace mobile home was placed on prescet I?q
e. Purchase P.Lcc 5 00 0 -�
1=1.='HOME fimo-'3•
I _
PE p'NO..
MASON COUNTY DEPARTMENT OF HEALTH SERVICES SITE EVALUATION AND INSTALLATION g c Date N �C Ci Date r s I
426 W. /P.O. 6/SHELTON, 8584 fe
'PHONE(206) -9670 Receipt No Receipt No. 0 v,
Amount$ 1 Amount$ Z
Z CHECK APPLICABLE ITEMS ✓
ILIrAD PRESS: DAYTIME ONE: INSTALLING NEW SYSTEM 4
(JEk /C. Y REPAIRING OLD SYSTEM
C STATE: ZIP: EXPANDING SYSTEM m
/l. S �Z 0 SINGLE FAMILY
PROPE ADDR OTHER Z
�.. S iy'7r - SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL IOU -><- $
2 00 c? 7. 0,` J-lrls7llj � PUBLIC SYSTEM
SYSTEM ID NUMBER
/�
Nw_�/_ C� SuvTN G G /m P,A ,C 7-V `//J SYSTEM NAME IN
SEE A*/'f L NEA iLJ�1 P APPLICANT
NAME r. n rN
Name of Lot 0 ft.x 6 $. ADDRESS C. ex, o�
Installer t /�D -o i Ilv
!,� TELEPHONE U sof
Dei;ie er�. [IE//'cRaNumbero S L q h
9 Bedrooms
PLOT PLAN ',"'
Draw a dimensional'pIA plan,'►: > r _,,i y �':.. :..� ...F
including: i IA
1 IG
it ❑Precise location of test
holes,showing
measured distances to .
property boundaries. O I O
❑Entry road;other roads,
driveways.
i r X.
NOTE: DO NOT DRAW IN
1 --- `r.-7-1--- ---
SYSTEM DESIGN 1 ---- [i•�+.., `fie-�-__
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
µ SOIL LOGS 7k 14
/N Z '
l l"� 0-r�"r�mvcu y h►y n, a�l
o-rb �i /t 60 rt1-t 11,Lf
I� (4"SPA-err y l�Sb (L�m��tH
F/wt S4 r%i'(f. S �f,AO ems r" It-,
ri �Arr 'i#Q
i� istrls 7Q filar �' �y Depth from
Grade R Original 1
Layer or Watertl abler-J`� In. 1
DESIGNER DESIGNATION SCORES ;.. MINIMUM SYSTEM REQUIREMENTS
Design: Level One 0 Level Two
Soil
Vertical Separation 1 C.14t I ' Septic Tank Daily
r Capacity: / Gal. Flow: GPD
Slope �L- \ Tllnfilt. ep rom ngma
A/ uq AC ppl' Grade to Bottom of
Parcel Size 0, ,/- Rate GPD/Flrea .. FT' Absorption area:
Distance to Shoreline Total 'ice Inspector Date
} COMMENTS/CONDITIONS FOR APO RNAL
I l�'�Prr N7�►ti� NZ l Sf'16�tS_
? Sr�Lr CL'c>tf1� ' tjo4f A 1"41C 1'�t l
0 Owner/DesignerAnstaller must meet on site to verify precise system layout O Owner must arrange pre-installation conferences with health dept.staff
0 Winter observations required U Extreme care needed during site preparation to preserve existing topsoil
Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.J
This Permit expires 3 years from date of issue.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE: Required O Not Approved DESIGN: U Approved ❑Not Approved INSTALLATION-0 Approved O Not Approved i
BY: i DATE: I_ /3 BY: DATE: BY: DATE:
APY81* TOP:Health Dept.Copy MIDDLE.Designer's Copy BOTTOM:Applicant's Copy
HUNT MANUFACTURED HOMES, INC.
l ECONOMY SALES DIMION
P.O.Coax 789 a Gorst,Washing m !'AW7
Pho,e:(206)479-7474 • FAX:(205)4793830
In this contract the words,L ME.and MY refer to the Buyer and Co-Buyer signing this contract.The words YOU and YOUR refer to the Dealer.
Sublect to the terms and conditions on both sides of this agreement you agree to sell and I agree to purc&a—se the following descrl unit.
BUYER(S) r 1 PHONE 5 7 DATE ZZZ
ADDRESS !i� SALESPERSON
DELIVERY ADDRESS
MAKE&MODEL YEAR BD ROOMS FLOOR SIZE HITCH SIZE Szzl
TOCK RR
rNUMBEy
SERIAL IVUMaER V - COLOR PROPOSED DELIVERY DATE KEY NUMBERS
E� ❑ USED
LOCATION R-VALUE THICKNESS TYPE OF INSULATION BASE PRICE OF UNIT $
CEILING I-- - OPTIONAL EQUIPMENT
EXTERIOR
FLOORS SUB-TOTAL $
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND
IS DISCLOSED IN COMPLIANCE WITH THE FEDERAL TRADE COMMISSION RULE SALES TAX
16CRF, SECTION 460.16.
OPTIONAL EQUIPMENT, LABOR AND ACCESSORIES NON-TAXABLE ITEMS �' J
$ VARIOUS FEES AND INSURANCE
1. CASH PURCHASE PRICE $ 6Q c
TRADE-IN ALLOWANCE $
LESS BAL.DUE ON ABOVE $
NET ALLOWANCE $
CASH DOWN PAYMENT $
CASH AS AGREED
SEE"REMARKS" $
2. LESS TOTAL CREDITS $
SUB-TOTAL $
SALES TAX If Not Included Above, ,
3. Unpaid Balance of Cash Sale rice $ Q &-Zp
Remarks:
ra
Price kidudec delivery&Set-UP Of this Mobile Hwne on
customers preparcd site a^.coSa!e by trudL 20 fsSI of
sever and water firm. to above around connecfion is In-
cludcd. Customer Is res orsiblo for e!eciri(iil h00%-u
and of obtaining any ragufred srrn's or irn ectiono.
Tirs3 and axlas are not Included In urchs o rfca of
home. Price does not Include skiftina or gutters.The o
Items must be r ested-
BALANCE CARRIED TO OPTIONAL EQUIPMENT a
NOTE:WARRANTY AND EXCLUSIONS AND LIMITATIONS OF DAMAGES ON THE REVERSE SIDE.
DESCRIPTION OF TRADE-IN YEAR SIZE You and I certify that the additional terms and conditions
MAKE MODEL BEDROOMS printed on the other side of this contract are agreed to as a part
TITLE NO. SERIAL NO. COLOR of this agreement,the same as if printed above the signatures.
am purchasing the above described trailer, manufactured home
AMOUNT OWING TO WHOM or vehicle; the optional equipment and accessories, the Insur-
ance
ANY DEBT I OWE ON THE TRADE-IN IS TO BE PAID BY El YOU El ME from all laimsiwht o aevhasbeer,excel t as unta notedt my trade in is free
THIS AGREEMENr CONTAINS THE ENTIRE UNDERSTANDING BETWEEN YOU AND ME AND No OTHER REPRESENTATION OR INDUCEMENT,VERBAL OR WRITTEN,HAS BEEN MADE WHICH IS NOT CONTAINED IN TM CONTRACT.
l W /p AGREEMENT,WiLHAVE
SIGNED XZZ112 v BUYER
HUNTt4'.ANUFaC7UREA HOMES,fi',lC. _
Not Valid Unl ss Signed and Accepted by an Officer of the Company. DEALER SOCIAL SECURITY NO /
B SIGNED X BUYER
Approved SOCIAL SECURITY NO. (82,83-10)
ORM 500.3WEL I ® A PLAIN LANGUAGE PURCHASE AGREEMENT Copyright019e3 JENKINS BUSINESS FORMS,MASCOUTAH,IL 62258
TRIPLICATE
Show fohTr,�.,ing on the si 'P nrarr
Plumbincr FixtureG ($2. 00 each) Fee: No. Boilers/Compressor
No
Lot Dimensions . Toilets Fees:
Flood Zones 0-3
Existing Structures Fences Bath Basins HP 00
Structure Setbacks Bath Tubs 3-15 HP —�0
water Lines Driveways
Shorelines ( 15-3 0 HP 6 00
Drainage Plan ( Showers
Septic System Topography Ef 3 0-50 HP 5.00
Proposed 00
wales Hot Water Htr
Name of Flanking ants Easements 50 + � 5.00
ankin Street Laundry Washer
Name Of Fronting Street Scale:, -Sinks
No. Air Handling Unit
Date: - - - Floor Drains
PLICANT TO DRAW SITE PLAN Laundry Basins <� 10, 000 cfm. 7 50
r
�S7-I rU o� -- > 10, 000 cfm.
Z Dishwasher7.50
PQ'U0 k Disposal
fa dL klU/Lu. `' Urinals Other
Other FOP Coolers
Hoods
Permit Basic Fee Fire Suppression
3.00 Domes. Incin.
f
TOTAL PLUMBING $
COmml. Incin.
fQv Reloc/Repair
Mechanical Fixtures Gas Outlets x 2.00 6.00
x No. Fuel Types Woodstove
- Furn < 100R BTU 6.00 separate
F'urn >= 100K BTU 6.00 Other
Furn
Heat - Floor 6.00 Permit Basic Fee I0.00
• mps
0 TOTAL MECHANICAL $
Vent System x 3.00
Vent Fans x 3.00
PLIT TO DRAW TOPOGRAPHy PROFILE BELOW NOTICE:
CAN THIS PERMIT BECOMES NULL; AND, VOID IF WORK OR. CONSTRUCTION
AUTHORIZED IS NOT CO��NCM WITHIN 180 DAYS, OR IF CONSTRIICTION OR ➢PORR:.IS
COMMENCED.SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTEg. ygOgg` IS
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
Fcontractors
hat I am exempt from the requirements of the I certify that I am a currents rs registration law RCW 18.27 , and am Y registered contractor in
the Mason County Ordinance requirements for the State of Washington and I am aware of the
s permit is issued and that all work done will °rdinance requirements regulating the work for which
formance therewith. No than es shall be the permit is issued and all work done will be in
g conformance therewith. No changes shall be made
tout>irst ning approval from the Buildingwithout first obtainin a
nt, ,,,- `� /l/e0offl
e, , g approval from the Building
✓/ `� Department.
X OWNER_N//� F,¢ V �viGT 7�/�/G X BY
DATE:
DATE
W Return permit to: Department of General Services
426 W. Cedar Street/P.O. Box 186
Shelton, WA 98584 427-9670/1-800-562-5638
FOR OFFICIAL IISE]ONLY: Accepted by: LC'+' �
Date.
DEPARTMENTAL REVIEW
MASON COUNTY Permit No.BLD
FOR OFFICE USE ONLY BUILDING PERMIT APPLICATION �L pq3
PLEASE PRINT
Planning: - Y-; y �
�Y1YY1 #1 wner T��IG/L2'; J�/a7RIC/.4 C� Gar-�=o� Phone# _246'- .7 - 46-7ZZ.
Site Address / G /L
--- /�lG- G/If
City F /� State VIik e
Directions to Job Site /LI/f f�
Environmental Health:
Q e
n a, gx, /6 y , �Lr•¢ir� , cv 9 �Z
Owner Mailing Address ,U ��', J 7, G
Building Plan Review:
Y1(T-� (7,7 City ��L/'/�/Yc' State Zip
Lien/Title Holder e-R WiLL lG N A)c15D f#K-dt)6
Address S^/�CU1('/7y A4,CIF/G
Occupancy Group:
City P,0. )3h. / 3/0 , VAIJC- 0 VCif State Wf4., Zip Md66
Fire Marshall: #2 Contractor Name L�:,' Contractor Reg #
Address Expiration Date
City tate
, _ Phone
Other: #3 If septic is located on project site, include records.
Connect to Septic?_ -i�-- Public Water Supply Well
(If residential, proof of potable water may be re ired. )
-7 YN )DeaC rSS O F f/gvju 6� Xe,071C_ ZOvr d
FEES _ #4 Parcel No. /23 Z/ %- O Z 0O D
Special Conditions• Legal Description S XZ A)4� �(79/ �F OG
Site Inspection
#5 Buildin Rs are Footage: (existing/proposed)
FF
Building Permit V�� UV 1st F1 2nd Fl / 3rd Fl / Loft /
Basement / Deck / #Bedrooms / #Bathrooms /
Violation Fee Garage / Carport / (Circle: Attached or Detached?)
Other sq ft /
Violation Investigation Fee
' #6 Use of building �z;51 DzN� Describe work
Plan Check � _ — ' r-,fl G rzaA c-E�
� �gilleK
#7 Type of Job: New x Add Alt Repair Demolition
Plumbing Fee Woodstove Re-roof Bulkhead Other
� I
Mechanical Fee #8 Mobile Home Information
Model Year I l� Make `LIi,ETLU00)j Model PUS 1)10 U�/z
Woodstove Fee Length Width /y Serial No. TO D D " 445R G 0-
#Bedrooms #Bathrooms 2 Type of Heat F Le re/G
Building State Fee
Building Valuation: + #9 Any water on or adjacent to property: Saltwater Lake River-
TOTAL . Pond Wetland Seasonal runoff Other