HomeMy WebLinkAboutBLD15709 Mobile Home - BLD Application - 6/20/1984 UILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
� 1 426-5593
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�v DATE ISSUED `�
PERMIT NO. l��e 5
OWNER ME MAILMI CITY STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE IM,j R
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. /Z alo
NAME MAIL AD CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF /7
BUILDING O/n z��( v &
Class of work: NEW ❑ ADDITIO TERATION E-BEPAfR ❑ MOVE ❑ REMOVE
Describe work:
191 7
Valuation of work: $ �� PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS _ CARPORT ❑ NOTICE
BATHROOMS ITOTAL SO. FT. GARAGE 7
NO. OF STORIES BASEMENT C ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE f DETACHED [
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I/ea
at I am a currently registered contractor in WORK IS COMMENCED.
t of Washington and I the
aware of the FOR OFFICE USE ONLY
requirements regulating the work for whicht is issued and all work done will be in
ce therewith. PERMANENT _ SHORELINES L!
SEASONAL Li FLOODPLAIN i_
Firm E.D. NO. S.E.P.A. L]
By Special Approvals IN OUT YES APPROVED NO
Lic. o. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conforrnance therewith. MOTOR VEHICLE PERMIT
Owner '044�4-WtDate
APP ATION ACCEPTED BY PLANS CHECK BY APPROVED FOR I
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
9
APPLICANT NAME: II� �� l -12,
BIIILDING PERMIT CHECKLIST
L-- 1. SITE ADDRESS
If site address is not listed, customer needs to be given
site address form.
DIRECTIONS TO JOB SITE
Needs to be as complete as possible (i.e. major roads, is
house on left or right side of road) Be sure to read for
clarity.
LIEN/TITLE HOLDER
Who holds the mortgage? (Bank or name of private owner
holding contract)
4JA2 . CONTRACTOR REGISTRATION # & EXPIRATION DATE
This information needs to be provided. Building Department
may be able to research expiration information if
customer doesn't know it. We must have a signature in 1 of
the 2 boxes, either the applicant or the contractor.
013 . SEPTIC RECORDS
Septic records should be included or be sure to inform
customer of $25 record research fee for Environmental Health.
If no records are available, make a notation on the form "No
Records" . If septic was just perked, please indicate in upper
left corner.
C 4 . PARCEL #
Parcel # must be included or researched through Gateway.
IApi5. BIIILDING SQUARE FOOTAGE
Verify that boxes are filled in. If there's a garage, verify
whether it is attached or detached. Include sq footage
information for mobile homes (you can multiply length X width
to determine number) .
i
6. USE OF BIIILDING
Is it a residence, garage, greenhouse, etc. . . ?
V DESCRIBE WORK
(i. e. mobile home addition, addition to a house, etc. . . )
7 . TYPE OF JOB
Verify boxes are marked.
8 . MOBILE HOME INFORMATION
Verify boxes are marked. If factory order, please put factory
order # in mobile home serial #.
'F
page 2 BUILDING PERMIT CHECKLIST
,9 . SHORELINES
If any water is on or adjacent to property within 200 feet,
#9 must be complete. Once permit is entered into Tidemark, it
will be routed to the Planning Department. If property is not
on water, then put "none" or "n/a" .
10 .SITE PLAN DRAWING
Must have setbacks from all property lines, easement lines
and structures.
w 11.TOPOGRAPHY DRAWING
If property is flat write "flat" on the topography section.
If house or structure is near a slope or hill, drawing must
reflect this.
+ 12 .OWNER OR CONTRACTOR AFFIDAVIT
Owner or contractor must sign affadavit statement and date
it.
13 .ACCEPTED BY
Whoever is accepting permit information must sign your
initials and date form on the bottom of page 3 or use date
stamp and initial on back of permit.
v 14 .PRINTS
Need two sets of prints unless it is a stock plan. For stock
plans, we only require one copy.
1 :-1, 15 .WATER ADEQUACY
For new residences and mobiles. Private wells must have well
logs or capacity test and bacterial test.
16.WSEC & V & IAQ CODE
Energy code applies to new residences, additions to new
residences and additions to living area for mobiles.
Compliance form must be complete unless the applicant has a
signed agreement with either PUD (#10 or #3) indicating
I participation in the Long Term Good Cents program.
17 .PLUMBING/MECHANICAL
This form must be completed for any structure with plumbing
and mechanical excluding mobiles/modulars.
� . 18 .FIRE DISTRICT
Please make sure the fire district is included in the
application information. Refer to map located at counter.
** DO NOT ACCEPT PERMIT APPLICATION WITHOUT PRINTS AND DETAILED
REQUIRED INFORMATION (SETBACKS, ADDRESSES, PARCEL# AND WATER) .
"permitck"
01/08/93
Top of
2 times the negm of Structure S�a4e =is = t
13' MOz.Z ce of
Paotn
Two
Nat to esc=ed
Foce of 1 Tae of
Structure Stape '
'!E BUILDING OFFICIAL MAY APPROV-
TYPIC.SI. STRUCTURAL SETBACX ALTERNATE SET'BAcxs s cLEARANCEs
Scale 1"
Sample Site Plan
2 41'
t S3' 14'
4a, 32'
G PROPOSED n ,
RESIDENCE
T Sep f
tic wt�
EDGE OF BANK 58.
24' c
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TYPICAL SITE PLAN In
J. OCE 1406 Masan Lk. Or.
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