HomeMy WebLinkAboutBLD93-1008 Final Mobile Home - BLD Permit / Conditions - 1/19/1994 MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
Ill 1,D 193 1008
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ONCRETE MECHANICAL MOBILE HOME
r"oetings-Setback date by Ribbons
e.le by Gas Piping date b
Foundation Walls date by Set Upj
date by INSULATION date a/Z� by
BG/SLAB Insulation Floors Final
date FRAMING by date by date °� — — `by A-L—
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
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O, Box 186 Shelton, Washington 98584
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Permit No, V1 -/60�
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
01 Owner Phone# �-X QLU-n1�8
Site Address Fire District#
City �p\�nn St WC." zip. r
Directions to Job Site L,� Li" c-�Ck nan-k e �\��- o ra (1kd-Q
�� Pica
Owner Mailing Addynn
ess jc, ':Q C�Q ���
City h� I :6 C , St (.�o�.. zip
Lien/Title Holder
Address CZV A-k�--
Clty St Zip
#2 Contractor Name Ol-t=c<< a p I LtT to Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on p✓rject site, include records.
Connect to Septic? Public Water Supply ✓ Well
Connect to Sewer System? Name of System L LL Y—Y d21 e i'�
(If residential, proof of potable water is required)
#4 Parcel N �- -
Legal Description
#5 Building Square Footage: (existing/proposed)
1 st FI $5h / 1,9�_2nd FI / 3rd FI / Loft /
Basement /��A / NI+ Deck / #bedrooms_ / 4 #bathrooms_L/ 15
Garage/I Carport / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building Describ work
#7 Type of Job: New—Add All Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year /9 y3 Make��`�`�-i-Model A/4-766 N
Length &Q/ Width gVel Serial No.
# Bedrooms 4 # Bathrooms Type of Heat Ekejr�C urn
Purchase Price $�6Q[)
t9 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
1
I
i
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbina Fixtures ($3 each Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No, Uni a Fees
Showers rn BTU
_Hot Water Htr _ He tpumps
_Laundry Washer Vent Systems
_Sinks Spot Ver Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins HP
Dishwasher No. Air H n lin ni
_Disposal _ cfm#
Urinals No. Fire Protection Systems
_Other Auto. Fire Alarm Sys 50.00
_ Fixed ire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ No. h r
Ga Outlets
W od, 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 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 e X BY
DATE DATE
FOR OFFICIAL USE ONLY:Accepted by: pe _ Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: rn
"I
Environmental Health:
Building Plan Review
fi 1 Z-'t
Occupancy Group: Type of Const:
Fire Marshal:
II
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