HomeMy WebLinkAboutBLD93-1730 Cancelled Mobile Home - BLD Application - 11/10/1993 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner (_'AD PPf A.4u C S+ Phone# a 7 S — 3 7 39
Site Address �r -4tt . )au,) Lo Fire District# IR
City (f A r St LL)A zip gg.,S l 8
Directions to Job Site _ To O Of 5 & 1-1 i LL- Le- t eLfa r WAt%
�2Q O 0 d y4 (P V_oA-d
Owner Mailing Address Pc, �c!;,, t9`t
City �--Lf A. St �• r Zip 9s L
Lien/Title Holder 12 (`c c r -t t L c
Address
City St Zip
#2 Contractor Name _I1 NAO P A 9.&)M U S b Contractor Reg#
Address R6 Expiration Date / /
City a c�F A� � St W A Zip 9 Y S'tIP, Phone#��S' ' 37 3 9
#3 If septic is located on pr ect 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.(COP, ogD "L
Legal Description �� � 1
#5 Building Square Footage: (existing/proposed)
1 st FI,?('0 Lm/ 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms_/ #bathrooms "Z /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
,�#6 Use of building I -s.5�CLLAk- _Describe work
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year&3—Make '.e,,) Model
Length _b5_Width 4 0 Serial No.
# Bedrooms 3 _# Bathrooms L Type of Heat &Lt.< . W oo
Purchase Price$ Q O G U "
#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
Show following on the site plan
Lot Dimensions Mood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
Alt
Lot' 2,,
t,o wc1 r�q�F
y38
0
3
ma',tiRo+�fl�\
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Units Fees
_Showers Furn BTU
_Hot Water Htr �' _ Heatpumps
_Laundry Washer Vent Systems
_Sinks — Spot 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. Sys 50.00
Permit Basic Fee V5.00 Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ . 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
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. DEPARTMENT.
uc,X OWNER q.)Pf )c'" 'j ti X BY
DATE �'S - j 2` DATE
FOR OFFICIAL USE ONLY: Accepted by ! �_? e- �� f
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review •TN Sy-A t-t, 2 9'►' F(--- Spe C.S 62 WAS(g la
Occupancy Group: ATE ype of Const: .SN
Fire Marshal:
Other:
Special Conditions: Ale) P/I#+N S 490* Sydiyr FEES
t0/L I+N 'V DV L6 C 2 yes> 7`� Building Permit
Od- 9141<-r- 1.,J4 fi 4eP",rn? ` i S Plan Check
L rrrV `>`f,
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE ��
1
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80S.C4' _ 621.22'
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328 .90' 328.90' 326 `ao' M sn°a4'27"
149 79'
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