The URL can be used to link to this page

Home My WebLink AboutBLD92-1514 Mobile Home - BLD Application - 1/16/1993 DEPARTMENTAL REVIEW - D -- Permit No.BLD I MASON COUNTY FOR OFFICE USE ONLY ' �rUII.,DING PERMIT APPLICATION ATION :.� N-" P G 9RAL SERVICES Planning: 6L.111,�� GENERAI #1 Owner 'G-- Phone# � Site Address Qt City State Zip Directions to Job Site Environmental Health: � ' - V Owner Mailing Address 0 . Building Plan Review: C UD State W6Zip 1CI Lien/Title Holder �J Address 355 J�5 - tCity StaeOccu Occupancy Group- Zip Fire Marshall: #2 Contractor Name_- Contractor Reg # Address Expiration Date City State Zip Phone Other: #3 If septic is located on n project site, include recor" Connect to Septic? Public Water Supply Well (If residential, proof of potable water may be required. ) FF FEES #4 Parcel No. In oa-- Special Conditions: Legal Description Site Inspection #5 Building Square Footage: (existing/proposed) Building Permit 1st F1 /�f�� 2nd Fl / 3rd Fl / Loft / Basement / Deck / #Bedrooms / / #Bathrooms Violation Fee Garage Carport / ! (Circle Attached or Detached?) Other �KA�� sq ft t'-,S// Violation Investigation Fee #b Use of building- Describe work Plan Check #7 Type of Job: Newer IPlumbingFee _ Add Alt Repair Demolition Woodstove Re-roof Bulkhead Other Mechanical Fee #8 Mobile Home information `V odel Year n _ Makel '. Model W e oodstove Fe_ Length Width Z Serial No. O #Bedrooms #Bathrooms Type of Heat Building State Fee Building Valuation: #9 Any water on or adjacent to property: Saltwater Lake River_ TOTALS Pond Wetland Seasonal runoff Other hw, Qhlowinc on n: Plumbing F' Lot Dimensions 1xturAa ($2.00 each) Fee:Existing.:Structures Flood Zones No. Toilets NO. Boilers/Compressor structure Setbacks Fences. _Bath Basins Fees: Water Lines Driveways 0-3 Hp Drainage PI Shorelines 0 ____Bath Tubs 3-15 HP Septic System Wells Topography Proposed well Showers 15-30 HP --5 00 Wellentss Basements Hot Water Htr 30-50 HP 00 Name of F1aT,Ir;ng Street Name of grouting street Laundry Washer 50 + gp --- 'Scale:.RAW SITE rDate:. _:,f Sinks --- APPLICANT TO D _Floor Drains NO. Air Handling PLAN BELOW. 9 Unit —Laundry Basins 10, 000 cfm. LAMOOf Dishwasher > 10, 000 cfm. -50 ,i- '�� —Disposal --7 50 W ,CkA, 0 Urinals Other Other Fvap Coolers Hoods Permit Basic Fee Fire Suppression TOTAL PLLTZMING Domes. Incin. - Comml. Incin. CID Mech_ ' F;,,�ures — RelOC/Repair No. Fuel Types Gas Outlets x 2.00 6. --�--Fern < 100K BTU Woodstove sew to Furn >= 100R BTU Other I • F1rn - Floor Heat Pumps �0 Permit Basic Fee ---�-� MECKANI�, --10 00 Vent System x 3.00 $ - f`lLG TOTAL Vent Fans x 3.00 _ APPLICANT TO D _:._. RAW TOPOGRAPHY PROFILE BELOW NOTICE: THIS PERMIT .BECOMES NULL AND 40ID: AUTHORIZED IS NOT C Cgg: p1ITHIN 1.80 DAYS-" OR IFFCONSTRUCTIOCONSTRUCTION CMMENDED OR ABANDONED FORA PERIOD OF- 18Q:..DAYS AT ANY:STRUC . -� -COMbD�7CED. N. 0&:..9PORR:;::IS : . :,.. . . _ .,. ...-. taP08K IS OWNERS AFFIDAVIT I certify CONTRACTORS AFFIDAVIT rtify that I am exempt from the requirements of the contractors registration law RCW 18.27 1 certify that I am a currently registered con aware of the Ma , and am tractor in son e Stat e to�-- County Ordinance requirements for of Washington and I am aware of the ° which this Permit is issued and that all work done will ordinance requirements regulating the work for which be in conformance therewith. No changes shall be the permit is issued and all work done will be in made without first obtaining a conformance therewith. No chanQeS shall be made Department. g approval from the Building g without first obtaining approval from the Building X OWNER Department. DATE: X BY DATE Return Permit to: Department of General Services Shelton 426 W. Cedar Street/P.O. Box 186 wA 98584 427-9670/1-800-562-5638 FOR OFFICIAL USE ONLY: � Accepted by: Date: l — 66"7- j��J�z DEPARTMENTAL REVIEW Permit No.BLD MASON COUNTY FOR OFFICE USE ONLY BUILDING PERMIT APPLICAT �S 4a_0j57 ��..•.� PLEASE PRINT LO Planning: 3 #1 Owner 1K- I Phone# �J' 3 1J Site Address City 2 State t Zip Environmental Health: Directio s to Job Site A� 1(1 �' � \ \ Owner Mailing Address i Building Plan Review: City State Zip \ Lien/Title Holder Address oar L - City � Lid. State Zip 22�7 Occupancy Group: Fire Marshall: #2 Contractor Name Contractor Reg # Address Expiration Date City State Zip Phone Other: #3 If septic is located on project site, include records. Connect to Septic? ✓ Public Water Supply %_� Well (If residential, proof of potable water may be required. ) FEES #4 Parcel No. I L�) Special Conditions: Legal Description FSite inspection FF xf�co 5 C-) #5 Building Square Footage: (existing/proposed) Buildina Permit lf5pL? 1st F1 2nd Fl / 3rd Fl / Loft / Basement / Deck / #Bedrooms / #Bathrooms / Violation Fee Garage Carport / (Circle: Attached or Detached?) Other p"L-vas sq ft / Violation Investigation Fee #6 Use of building L Describe work J�b, lncG P c' Plan Check #7 Type of Job: New Add Alt Repair Demolition PlumbingFee Woodstove Re-roof Bulkhead Other Mechanical Fee ' #8 Mobile Home Information t ,� Model Year � Make '\ Mode Woodstove Fee � � ' Length r Width Serial No. #Bedrooms #Bathrooms I Type of He Building State Fee n Building Valuation: #9 Any n or adjacent to property: Saltwater Lake River TOTAL ! Pond U Wetland Seasonal runoff Other none L -- - - - - i g Plumb nQ Fixtures ($2.00 each) Fee: No. Boilers/Compressor Fees: \� __� Show followin on the si P lan Y No. Toilets Lot Dimensions Flood Zones 0-3 HP 00_Bath Basins Existing Structures Fences 1 --r 3-15 HP 6.00 Structure Setbacks Driveways Bath Tubs 15-30 HP 6.00 Water Lines Showers Shorelines Drainage Plan Topography 3 0-5 0 HP 6.00 Septic System wells Hot Water Htr 50 + HP Proposed Improvements Easements 6.00 Name of Flanking Street Laundry Washer d— Name of Fronting Street Scale.. SinkS - No. Air Handling Unit Floor Drains 10, 000 cfm. Date: �Z' ��' '�� 7.50 APPLICANT TO DRAW SITE PLAN BELOW Laundry Basins > 10, 000 cfm• 7.50 Dishwasher Disposal Other Urinals Evap Coolers Other Hoods Fire Su � PPression ' Permit Basic Fe,6 3.00 Domes. Incin. TOTAL PLUMBING $ Comml. Incin. Reloc/Repair 6.00 �5 Mechanical F�,xtures No. Fuel Gas Outlets x 2 .00 Types� Wcodstove separate G` Finn < 100K BTU 6.00 Other rn >= 100K BTU 6.00 Furn - Floor 6.00 Permit Basic Fee 10.00 _Heat Pumps 6.0 TOTAL MECHANICAL $ �1 Vent System x 3.00 it a =Vent Fans x 3.00 R-1 APPLICANT TO NOTICE: THIS PERMIT BECOMES NULL AND VOID IF .PORK OR. CONSTRUCTION DRAW TOPOGRAPHY PROFILE BELOW AUTHORIZED IS NOT COMMENCED` WITHIN 180 DAYS, OR IF CONSTRUCTION 03L WORK;IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORT 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 in contractors registration law RCW 18.27 , and am the State of Washington and I am aware of the aware of the Mason County Ordinance requirements for ordinance requirements regulating the work for which which this permit is issued and that all work done will the permit is issued and all work done will be in be in conformance therewith. No changes shall be conformance therewith. No changes shall be made made without first obtaining g approval from the Building without first obtaining approval from the Building Department. Department. X OWNER > X BY DATE: 1Ic - DATE 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 USE ONLY: Accepted by: \ l Q n t- Date: ��