HomeMy WebLinkAboutBLD93-01161 Cancelled Mobile Home - BLD Permit / Conditions - 10/30/1997 MASON COUNTY PERMIT
Mason County Bldg. 111 426 W. Cedar NULL A YOID BY EXPIRATION
P.O. Box 186 Shelton, Washington 98584 DATE d BY
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date by
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date by date by
WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date by date by
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
I P.O. Box 186 Shelton, Washington 98584
Permit No.
MASON COUNTY
�� BUILDING PERMIT APPLICATION
%6 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT y- �p�(� t
#1 Owner Phone#1 o a, ) wm-.
Site Address_L(ol -'�-I f\ 0�_0 _ _ Fire District# 1J
City "-cA C-- St ux�\ Zip q��6�{
Directions to Job Site 1-V 0J�J a au L--\L an
TO -k-2-1\U kT E)\�-N 'Z�A L7-myx��
a>Z.Q L O-T-
Owner Mailing Address
City St upp, Zip
Lien/Title Holder �A�\F_'� t. STD MAc.H
Address
Clty St Zip
#2 Contractor Name OLUQy a c-�-'— Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on pro ect site, include records.
Connect to Septic? Public Water Supply ✓Well
Connect to Sewer System? Name of System t L-1 ° 1
(If residential, proof of potable water is required)
#4 Parcel No. 92l�7 - 32�. _CO1ya
Legal Description L-ON- \�A� �A�L� L�rn�Q �C,�`���)�St(�t�► y MAY�.I Go.lj,1 /_
#5 Building Square Footage: (existing/proposed)
1st FI / ►,QQPj 2nd FI / 3rd FI / Loft /
Basement / Deck / tCo #bedrooms / #bathrooms / 1
Garage / Carport / (Circle: Attached or Detached?)
Other sq.ft. /
#6 Use of building S�p`t 1.1Ci�i e Describe work
#7 Type of Job: New_Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year q'�> MakeMDb0 U 6Aodel M RO k,SVQ
Length '�)Cn I Width Serial No.
#Bedrooms 2 #Bathrooms ► Type of Heat 6>.F-c-TR-►C. r /A I f2
Purchase Price $
#9 Indicate by circlin the applicable source if any water is on or adjacent to subject property:
River Pond El>trearn 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 IaRAW SITE PLAN BELOW
ZIp.Co'?
0_ ,nip•`
721
� d
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
�'J
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 Heatpum
_Laundry Washer Vent Systems
_Sinks Spot e t Fans
Floor Drains N B it r m r r
_Laundry Basins HP
_Dishwasher No.. Air H n lin i
_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 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.
X OWNER X BY
DATE — DATE
. !. - - - - -- - --- -- ----
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: IZ
Environmental Health: Q-U �2.44-c If co t
MI
Building Plan Review —I T C
v - J
hotkyp
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
Building Valuation: TOTAL FEE ��