HomeMy WebLinkAboutBLD93-1205 Final SFR - BLD Permit / Conditions - 12/14/1993 l .
MASON COUNTY
Mason County Bldg, III 426 W, Cedar
P,O, Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date ` -� by C Ribbons
date'�-� - by �-✓� Gas Piping date b
Foundation Walls �/_ L date by Set Up
date 9- Z - R3 by INSULATION date by
BG/SLAB Insulation Floors Final
date by date date by
FRAMING 07< Walls L^D FIRE DEPT.
date L-)- / - by L--J date , -Z-- 13 by date by
PLUMBING Attic OTHER
Groundwork
date - CJ_ b date - l 3 by L r�
D.W.V. IA;lv- WALLBOARD eby
NAILING PUO f l nc,Q
date j� - I S-`� by
Water Line FINAL INSPECTION ( I
datV0 "/5-�73 �� by z- date OV 12 y'`3 by L._.J date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P,O, Box 186 Shelton, Washington 98584
abo No, t HI 0413-- I W,
for : PAPAOi` E Fig
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MASON COUNTY 0
BUILDING PERMIT APPLICATIO rinu4UL 199
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-52: 628
PLEASE PRINT ERgi ��ES
#1 Owner _/0 ��tt 4K. i S� 3,Z,4< G Phone# a
Site Address N,4-: j.J l A L l� R �'c Fire District#
city . _St zip 9z
Directions to Job Site c,7`65 A ,'L Le- -c S&x) Q e
Owner,Mailing Address
City 5'-g- St Zip
Lien/Title Holder
Address
Clty nn St Zip
#2 Contractor Name V"�t<g�`SP_ di*,t'. Contractor Reg#/541?;4 bbJ*WIN7
Address R Expiration Date ' / 2 Y /
City ;� ' St 4V1, Zip Phone# 1
#3 If septic is located on project site, include records.
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.I9-53 0 -571- DDD /D
Legal Description 13,'D 7 Ge' /V 6e� 49-
#5 Building Square Footage: (existing/` d)
1 st FI $`10 / 2nd FI G / 3rd FI / Loft /
Basement / De �,PC7/ #bedrooms '? / #bathrooms /
Garage _/ Carport / (Circle(Attache or Detached?)
Other 14Y6 sq.ft. /
#6 Use of building id!ezS . Describe work lVe Gr)
#7 Type of Job: New ✓ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
Purchase Price $
#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 P N BELOW
�GQm�`RA� Wd y
� W
5� G ti1� jj*rs4f
s
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 eacbj Fee Mechanical Fixtures ($6 each)
No. Toilets / CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
-Bath Tubs No. Units Fees
_Showers _ Furn BTU
_LHot Water Htr _ Heatpumps
Laundry Washer _ Vent Systems
02
Sinks 4 & Spot Vent Fans
_Floor Drains No. Gg i rl m yA9 r aL�00
_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. Sys 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 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY OD
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 BUILDING DEPARTMENT. DEPA MEN,j
�� ,Se 641,cis �ti
X OWNER X BY
DATE DATE
�FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan evie
Occupancy Group: Type of Const:
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
r
Building Valuation: TOTAL FEE