HomeMy WebLinkAboutBLD93-1093 Cancelled Mobile Home - BLD Permit / Conditions - 5/23/1994 MASON COUNTY
Mason County Bldg. 111426 W. Cedar NULL & VOID BY EXPIRATION
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P.O. Box 186 Shelton, Washington 98584 DATE 13
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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 O7/ -/-T y by �. J
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT Q(,W Od3
#1 owner Phone#
Site Addr ss -�� ���� (c O,�_ Fire District #
City PJ l V St UJA Zip 9W�S 2
Directions to Job Site C� I-�S! C V
r' .tea �•, r �vz, /s
u� dam- GJ�s
y' S. J e-
Owner Mailing Address p )x u
City St Zip
Lien/Title Holder
Address-�P0 11
City St Zip 8S
7 .
#2 Contractor Name
Contractor Reg#-�CS F2L2280.�
Address QC7, Emig 1 Expiration date `q
City RE LCW(L StWAZip S_2'3 Phone 2 -IS— 66"-9�
3 If septic is located on project site include records.
# P P 7
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water is required)
#4 Parcel No.,2�0 -32. - 002�(Q
Legal Description 'TQ 2.� OF C,DT at �
#5 Building Square Footage:
1st Fl-A6 2nd Fl 3rd Fl Loft Basement
Deck #bedrooms-3 #bathrooms l Garage Carport
Garage/Carport: Attached or Detached
Other
#6 Use of building Describe work
#7 Type of Job: New Add Alt Repair Demolition
Re-Roof Bulkhead Other
#S MOBILE HOME INFORMATION _
Model Year (may Make Model Par t c
Length 5 Width_ Serial
#Bedrooms #Bathrooms_ Type of. Heat G�(e
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
J
-+-'tier•-
Show following on the site plan 1
Lot Dimensions Flood Zones
Existing Structures Fences '
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELOW
5
5
L'N�
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� LA
fe
_9
Q
Q
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Id
OR
. pox
o� 0(7 00 of
ing Fixtures Fee Mechanical Fixtures
No. 7_Toilets Primary Heat Source (circle type)
Bath Basins Elect/heatpump/other
Bath Tubs
Showers NO. FEE
Hot Water Htr Furn
Laundry Washer Heat Pumps
Sinks Vent Sys (Central)
Floor Drains Vent Fans (Spot/Whole)
Laundry Basins Boilers/Compressors
Dishwasher HP
Disposal Air Handling 'Unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee
TOTAL PLUMBING $
Other
Gas Outlets .Hookups
Wood/Pellet/Gas Stove
Other
Permit Basic Fee
TOTAL MECHANICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE .5-1 9 DATE
Return permit to: Department of General Services .
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
.::.::..:.:.........................
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY ,4
Approved Cond Hold
Approval
Planning: -\N
Environmental Health:
Building Plan Review: >v,i� i.LLC—
Occupancy Group:
Fire Marshal:
Other:
FEES
IlSpecial Conditions: #c) RM03 II 11Site Inspection I II
11 -Sc4amrrreb
11. llzf�eft yo A Bu> IlBuilding Permit I II
II r1u/� - ,�� ri is R61106 II 1'
'7-h ta,l 't-k 4!T-- A-e&S 11 IlViolation Fee I 11
Ii 11 11violation Investigation Fee I 11
II 11 I' --- --- 'I
11 11 II Plan Check I II
II II
II 11 II Plumbing Fee I II
II— 11
II 11 11mechanical Fee 1 11
II 11
II II . 11Woodstove Fee I II
II 11 I I
II 11 1113uilding State Fee I II
11Building Valuation: III II TOTALI
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