HomeMy WebLinkAboutBLD97-00354 Cancelled Mobile Home - BLD Application - 11/9/1997 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION k` \ �
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 p, C,���q� �`�
PLEASE PRINT 'C Q.� ,��
#1 r Phone#
it Address G Fire District#
it
StZip
Directions to Job Site C 1r`�
Owner Mailing Address
City � C � St Zip
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name �- Contractor Reg#�J3t2x'hl
Address c G L - Expiration Date_ 7
City St Zip 5 Phone#c.�--V&
#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 r sidential, proof of potable water is required)
#4 rcel No. - S - O O
Legal Description Q J L
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck(3x 4-7 #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. -4�;z _/
#6 Use of building E F/L Describe work
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED ME INFORMATION
Model Year G C Ma I Model
Length Width .S 2 Serial No.
#Bedrooms _#Bathrooms Type of Heat
Purchase Price a_Z 7 �y�-5 ,
#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 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 PLAN BELOW ,
lo,
U• G
� Y
.Q
T Wj 7J -
v
r
cJ
u
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing_Fixtures ($3.35 eachl Fee Mechanical Fixtures ($6.75 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
�Laun
ater Htr Heatpum s
r Washer Ven ystems
y`�
_Sinks _ Spot Vent Fans
__Floor Drains No. Boilers/Compressors
Laundry Basins _ HP
Dishwasher NoNN
Air Handling Units
Disposal cfm#
Urinals Fire Protection Systems
Other Auto, Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 16.75 _ "Auto Fire Sprink Sys 35.00
TOTAL PLUMBING $ No. Other
Gas Outlet
Wood, Gas, Pe t 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 16.75
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $
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 OFTHE 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 BUILDIN�C EPARTMENT DEPARTMENT.
X OWNER 1 X BY
DATE`'l ,/I. DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
�Prov
ed Cond. Hold
Approval
Planning: (�l�i " �e}bc�1�S �,!��/ ?Z R
Environmental Health: yA-�
Building Plan Review
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 1��� a:¢
Other
Building Valuation: TOTAL FEE
r
• a �
I
s
rl)
NO
l s;
I�
CK f
0
i
MASON COUNTY
426-5593 BUILDING DEPARTMENT N° 1 2 8 9
ALL PERSONS ARE HEREBY ORDERED TO AT ONCE
STOP WORK
On these Premises at .C?.L/./.......... .................................................................
..................................................................................................................-..........................................................._............................_.......................
This order is issued because .... ........Ak...... ..._.....b.. — ..! .............
.. `�.�........ ....................._..............................................................................................................................................................
c /
Posted ..... . ...�. ... P.M. ..... ..I�.�.. �............ 19...14.... By ...
!-- r ....
WARNING The failure to stop work, the resuming of work without permission from the
Building Official, or the removal, mutilation, destruction or concealment of
this Notice Is punishable by fine and imprisonment.
I
- r� l
I
� � BUD