HomeMy WebLinkAboutBLD94-0402 Mobile Home - BLD Permit / Conditions - 4/1/1994 MASON COUNTY
Mason County Bldg, 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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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 .- ZC7— 7CI by z-
BG/SLAB Insulation Floors Final
date by date by date c1— Z 3 — 7 c by L J
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date by date by s, 10
D.W.V. WALLBOARD NAILING
date by date by 1
Water Line FINAL INSPECTION
date by date by date by
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
F.O. Box 186 Shelton, Washington 98584
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MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION ao�'
426 W. Cedar/P.O. Box 186, ,�a
Shelton, WA 98584 427-9670/1-800-562-5628 ��, ,
PLEASE PRINT
#1 Owner 12111SS'aLL 4/' /`�9/1✓✓, �02o Phone# 2 2.i-G 9/2
Site Address 0E,496 Li r5UY1 -6lVd Fire District# 2
City St ikl,4 Zip 9�S2B
Directions to Job Site ✓D,
ZO T 0,e-7 L,q eSo,�/f�LV7->
�L�DO.c/E2 LOoI�-
Owner Mailing Address D- 'Edx /10174
City St k4 Zip 9f.52B
Lien/Title Holder 6' VmrA Ali ✓c
Address
Clty St Zip
#2 Contractor Name '1 (sle� Contractor Reg#
Address Expiration Date
City St Lk-pk Zip Phone#
#3 If septic is located on project site, include records. ,f/Ful �`�A�ic S�S��' -'�psi'?o✓�I L ///«osED
Connect to Septic? Public Water Supply ! Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No.I. 330 .51 - PJ
Legal Description P/V 4L L07-44 /3F,4E0
#5 Building Square Footage: (existing/proposed)
1st FI I SL49 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other nn sq.ft. /
#6 Use of building 1[ P Describe work
#7 Type of Job: New ✓ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year 199S MakeF4/0444 Model
Length G(or Width 2,9' Serial No. 7390
# Bedrooms .3 # Bathrooms Z Type of Heat EG c
Purchase Price$ 3/, �a a
#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
r
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
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
'yam i2 ' S,7
2 D2,41AI
�p &6VL9
Ma6i�F Dom. 92
� O
1212
12 4,41
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
log 6'
LEI/i47/ONS A 90V�� ���f ��a�•✓
1
Plumbing Fixtures ($3 eachl Fee Mechanical Fixtures ($6 each)
No.2 Toilets CIRCLE FUEL TYPE: Gas Electric,
2 Bath Basins Heatpump, Other
Bath Tubs Units Fees
owers — Furn D po0 BTU
Hot*ater Htr Heatpumps
Laundry`Washer Vent Systems
—Sinks Sp0# Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins \ HP
Dishwasher No. Air Handling Units
_Disposal cfm#
_Urinals No. Fire Protection Systems
Other \ _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sy 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 15.0
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 OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDIN 1EPARTMENT. DEPARTMENT.
X OWNER A X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: 4; Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review I S cC-S H G/ N p;�J S v 5' pDw e S
Occupancy Group: _ " ype of Const:
2 _�
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE �O '