HomeMy WebLinkAboutBLD93-0369 Move Mobile Home - BLD Application - 3/26/1993 s w
Permit No. .�-t�► (�
r MASON COUNTY
BUILDING PERMIT APPLICATION
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#1 owner lykm"�'lw PdjCretl- Phone#
Site Address c"-"_ :,2 e / �o4 Zh Fire D3*J t�tME# VICES
Cit St zip
Directions to Job Site
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Owner Mailing Address
City St zip�9rrs-
Lien/Title Holder i
Address
cit St e c2A
#2 Contractor Name Contractor Reg#
Address Expiration date
City St Zip Phone
#3 If septic is located ohs project site, include records .
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water is required)
44 Parcel No. 12 2 11 3 -26
Legal Description %^
#5 Building Square Footage:
1st Fl_ �0 2nd F1 3rd F1 Loft Basement
Deck #bedrooms #bathrooms 2 Garage Carport
Garage/Carport: Attached or Detached
Other
C� 6
#6 Use of building 2z ?J��/U'T7 n- Z Describe work /'l1a�/�
__1,77G 13/L e �K d& f'T Gt Iy 4 / L TTl s?/G- o `t/ _ . ,tr .4
#7 Type of Job: Newer Add Alt Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year 'F 6 Make Model i UDR si��-
Length S `o Width $ Serial No.
#Bedrooms #Bathrooms 2 Type of Heat faAc /,- //Z
#9 Any water on or adjacent to property- ltwater lake
river pond wetland seasonal runoff
other
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 -D TE PLAN BELOW
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To ,b'r rNo p
Rp�f�s�c �20'
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=APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
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Plumbing Fixtures Fee Mechanical Fixtures
No. Totl.ets Primary Heat Source (Circ,ke tym)
Batik Basins Elect/heatpump/other
Bath Tubs
Showers NO. \ FEE
Hot Wager Htr Furn�
Laundry \Washer Heat 'Pumps /
Sinks Vent Sys (Cen /al)
Floor Drain Vent Fans (S /Whole)
Laundry Ba� ins Boile\ s/ ompressors
Dishwash HP
Disposa Air Ha '41ing Unit
Urinal \ cfm.
Other, \ Fire rotoction Systems
Permit/Basic Fee
TOTAL PLUMBING $
i
l
ther
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 RCN 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. DEPARTMENT.
X OWNER X BY
DATE 2 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 OFFICTnT• VS� ONIrY Accepted f TJate
o
DEPARTMENTAL REVIEW A
FOR OFFICE USE ONLy
[Approved Cond Hold
Approval
Planning:
Environmental Health:
Building Plan Review: (1
,
Occupancy Group:
Fire Marshal:
Other:
FEES
IlSpecial Conditions: II llsite Inspection I II
it II
II 11 IlBuilding Permit
II II I'
II II Ilviolation Fee I II
II II II 'I
11 II llviolation Investigation Fee 1 11
II 11 II 'I
11 11 IlPlan Check I II
11 11
11 11 IlPlumbing Fee I II
11 11 II
11 11 IlMechanical Fee I 11
11 11 1 i
11 11 IlWoodstove Fee I II
II II II it
II 11 IlBuilding State Fee I L`
I' N Ii
IlBuilding Valuation: 11 II TOTAL I II
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton,Washington 98584
(206)427-9670
BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
November 10, 1993
EDWARD PARKER
P.O. BOX 57
GRAPEVIEW, WA 98546
RE: Building Permit Application
Dear EDWARD PARKER,
Records indicate a building permit application was submitted over
four months ago. This application has been placed on hold needing
additional information for the Health Department to complete their
review. To date the health department has not received the required
information.
I (we) will supply the necessary information to the
health department in the next two weeks.
I wish to cancel my permit .
If the health department does not hear from you within the next two
weeks, from the date of this letter, it will be assumed that you do
not want to pursue this project further.
If you have any questions please feel free to contact me at 427-
9670 .
Sincerely,
Mark Tompkins
Environmental Health Specialist