HomeMy WebLinkAboutBLD94-00180 Mobile Home - BLD Permit / Conditions - 10/1/1994 MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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bit pull tO Ailf-ACIIIIED CONDITIONS IS REQUIRED
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping dateOL -W- gt-
Foundation Walls date by Set Up . J
date by INSULATION date by e !_)W
BG/SLAB Insulation Floors Final
date by date by date / 2 �f by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
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. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY a
BUILDING PERMIT APPLICATION 40 0
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 �V 1 �
PLEASE PRINT
#1 Owner J" 60*e-J Phone# 2US 3c((6 - L(e)-6 " —219
Site Address at i4 " Fire District# >�
City St Zip
Directions to Job Site flr t Jc`y",tr:c C Ec'U`S-t r a Et7q T
'f° d s 6
-i- S - c� l d-of R
Owner Mailing Address
City r4 c (,. 1 St Zips 2-
Lien/Title Holder nc�/Vu tl-
Address
Clty St Zip
#2 Contractor Name c fr Contractor Reg# W
Address Expiration Date 8 /"2c:) / c
City 40 St ZipfZ-5- 2 Phone# c§'�c 3
#3 If septic is located on pro' ct 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) Z-,q L�c
#4 Parcel No.. L- 2. -2- -5--3- Q 016 `)
Legal Description (/ p e' C (t VVI ev" C�c
#5 Building Squ ootage: ( isting/proposed)
\�A1st FI 75-0 2 d FI / 3rd FI / Loft /
Basement / Deck I/!O*�#bedrooms #bathrooms _/
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Use of building / �V! f G �. Describe work (.tflt KP S'
Awd "-' C( "fl t- O ) o r I t vl- ,
#7 Type of Job: New ✓ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INF RMATION
Model Year Make W XVI^ odel X7 d
Length / Width h Serial No. bib
#Bedrooms #Bathrooms :2- Type of Heat r=/f cfv' t,L
Purchase Price $ -i Coo
#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
$�( 31
F'
<vtof
7�
6
Lot �v
GC, 1 6r-
3 -
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
P rot 2-
F
t.o n
s
dot Vt
6 c�
5/01 e
( COyr
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
ath Basins Heatpump, Other
_B h Tubs �% No. Units Fees
Sho ers Furn BTU
Hot W ter Heatpumps
1
_Laundry asher Vent Systems
Sinks _ Spot Vent Fans
ts
Floor Dr in Boilers/Co m re_rer rs
_Laundry Basins HP
Dishwasher No. Air Handling ni
_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 No. 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
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 OBTAIMG AI',PROVAL FROM THE BUILDING
THE BUILDING DEPART T. DEPARTMENT.
c
X OWNER�� �t-�, �21i1�ttia�- X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: Dater
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: �ry111titW CpYoCcy-'s
5'e !'MGi i of 11 L C—
Environmental Health: �,,ntit i TI D h4 S
� I"L' 1N4
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
Other
Building Valuation: TOTAL FEE l��5