HomeMy WebLinkAboutBLD94-00979 Final Mobile Home - BLD Permit / Conditions - 9/1/1995 MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback dat, by Ribbons
date by Ga Piping date b
Foundation Walls da by Set Up
date by IN ULATION date by
BG/SLAB Insulation FI ors Final
date by d to by date by
FRAMING alls FIRE DEPT.
date by d to by date by
PLUMBING OTHER
Groundwork is
date b ate by
D.W.V. ALLBOARD NAILING
date by date by Gs /4�L
Water Line FINAL INSPECTION
date by dat 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
P.O. Box 186 Shelton, Washington 98584
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION 'c� °1
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT ,J
#1 ner L O h i1) . S i E Phone#
ite Address A o2 yi ire District#
City ' a, 5J a St—Zip
Directions to Job Site
�C.d
0K 7
Owner Mailing Address GA-4
City St Zip
Lien/Title Holder
Address
City ip
#2 Contractor Name � ` "—Cont a*
Address r� ,�xpiration�ate
City St Zip one#
#3 If septic is located on project site, include records.
Connect to Septic? x' Public Water Supply L1 Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 rcel No.
f� �I
Legal Description
#5 Building Square Footage: (existing/proposed)
1 st FI / 2nd FI / 3rd FI / Loft /
Basement / eck / #bedrooms / #bathrooms /
Garage / Carport / (Circle: Attached or Detached?)
Other sq.ft. /
#6 Use of building Q10 Describe work
#7 Type of Job: New ✓ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year 5 Make_ Model
Length Width Serial No.
#Bedrooms _#Bathrooms Type of Heat
Purchase Price$_//a OOD
#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
y
LT L.�lev
- u �
- - ---
�; , - -
p
m e Rd
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
i� �o •
V
Plumbing Fixtures ($3 each Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. UnitsFees
Showers Furn BTU
Hot Water Htr _ Heatpumps
aundry Washer O _ Vent Systems
_Sinks Spot Vent Fans
_Floor Drains Boilers/Compressors
_Laundry Basins — HP
_Dishwasher No. Air Handling Units
_Disposal cfm#
_Urinals Fire Protection Systems
_Other _ Auto. Fire Alarm Sys 50,00
ed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 — Aut Fire Sprink Sys 25.00
TOTAL PLUMBING $ No. Other
Gas Out is
Wood, Ga 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- 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 BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE '�,•' I �� DATE
FOR OFFICIAL USE ONLY: Accepted by: - Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review M G
Occupancy Group:IZ= Type of Const: -5"N
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