HomeMy WebLinkAboutBLD93-0346 Cancelled Mobile - BLD Permit / Conditions - 11/3/1993 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 Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date - J J- `% / by /
BG/SLAB Insulation Floors Final
date by date by date �- /�� �j�/ by
FRAMING Walls FIRE DEPT.
date b d b
Y ate y
PLUMBING date by
Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
I
1
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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- a
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION JQ_3-0
PLEASE PRINT
#1 Owner-DW/A) �'7` �/�s e P h o n e#
Site Addres � '�� Q'- �" �w�Fire District #
City �' St W19 Zip
Directions to Job Site S L ' tiled
Owner Mai in Address A)EF v
City r- St Zip 07 35' `-
Lien/Title Holder o el- 1
Address
City St Zip
#2 Contractor Name Contractor Reg#
Address Expiration date
City St Zip Phone
#3 If septic is located� project site, include records .
Connect to Septic? k, Public Water Supply_4)(— Well
(If residential, proof of potable water is required)
#4 Parcel No. � > t� it
�' 1�7►
Legal Description ge... r4S egos_ 1 y Lv7�
#5 Building Square Footage: aoo I Gr 4% / 17ull UAa
oqst Fl 2nd F1 3rd Fl Loft Basement
eck #bedrooms .3 #bathrooms Garage Carport
Garage/Carport: Attached or Detached
Other nn
#6 Use of building ��� 5 1 �e� Describe work 11[D15/L&
#7 Type of Job: New V Add Alt Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION /
Model Yearl9`7.3 Make L 9 &r4 Model 6*24
Length--y � Width .i � Serial No.
#Bedrooms #Bathrooms Type of Heat lGG
#9 Any water on or adjacent to property:,-saltwater lake
river pond wetland seasonal runoff
other
Ar V.
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 Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELOW
301
2g �
Says 74e,
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
r<
1 _
$iumbinq Fixtures Fee Mechanical Fixtures
No. 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. 12 DEPARTMENT.
X OWNER X BY
DATE -22 mZr DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427 -9670/1-800-562 -5628
.
FOR OFFICIAL USE ONLY Accepted bar bate
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond Hold
Approval
Planning:
�nrns
Environmental Health: PIJ
Building Plan Review:
Occupancy Group:
Fire Marshal :
Other:
FEES
Ilspecial Conditions: 11 11site Inspection 1 11
11 11 H i I
11 II IlBuilding Permit I
II II Il � I
II 11 11violation Fee I II
II 11 1' 'I
11 11 11violation Investigation Fee 1 II
II Il
II 11 II Plan Check I II
II II I I
II 11 II Plumbing Fee I II
II 11 I
11 11 11mechanical Fee I II
II 11 1
it 11 IlWoodstove Fee I II
II 11 L it
II 11 IlBuilding State Fee 114.I GOII
IlBuilding Valuation: II 11 TOTALI 6 V