HomeMy WebLinkAboutBLD93-00627 Cancelled Modular Home - BLD Permit / Conditions - 10/15/1997 MASON COUNTY PERMIT
Mason County Bldg. 111 426 W. Cedar NULL VPID BY EXPIRATION
P.O. Box 186 Shelton, Washington 98584 DATE Zq" BY
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
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 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. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT /h
#1 Owner J(1 r �{ / ��r✓i S am Phone# Lt 2 G — 4SS3
Site Address Lake- Fire District#
City t Lf 10Z St ` Zip
Directions to Job Site D' Go 10 d
�o
L t
Owner Mailing Address Jig pig ci {-T SL
City St zip
Lien/Title Holder wh CA
Address
City St Zip
#2 Contractor Name 4le i& (!t Contractor Reg #
Address Expiration Date
City St Zip Phone#
#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 residential, proof of potable water is required)
#4 Parcel No.,�2 � - 5 L- 00 1'0 2-
Legal Description D;v /-o fi L 9 -7
#5 Building Square Footage: (existing/proposed)
1 st FI / 2nd FI / 3rd FI / Loft /
� Basement / Deck / #bedrooms / #bathrooms /
�arage / Carport / (Circle: Attached or Detached?)
Other sq. ft. /
#6 Use of building Describe work 6e.A-v 3
eJ� Mir,. J/wt2_
#7 Type of Job: New V Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year q3 Make L,' -, Model O 0<Z
Length 4 4- r Width 7 8 Serial No.
# Bedrooms #Bathrooms Z Type of Heat
Purchase Price $
#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 3LAN BELOW
10
1
F
130
M
i
V
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. ni Fees
Showers Furn BTU
_Hot W tr _ Heatpumps
_La ndry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains Boilers/Compressors
_Laundry Basins HP
Dishwasher No. Air Handling Units
_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 FirpTinfc _ 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 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 1— DATE
FOR OFFICIAL USE ONLY:Accepted by Dater`} �f
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health: 2E SQ \tc
�v
Building Plan Review4&uAl A —/ylGts--
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