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HomeMy WebLinkAboutBLD97-01302 Cancelled Mobile Home - BLD Application - 11/10/1997 Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670 �� 9— (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269) PLEASE PRINT # r kPhone#� ) ite Address 'i " Fire District#"r ity _ St \A/A Zip 1 Directions to Job Site 4 A4L+ � o 'AL- Owner Mal ing Address o DA'- W City G,Aa St—W—Azip 9 S 5¢� Lien/Title Hold r Address City St Zip #2 Contractor Name AU B I # (,Q $ Sir►p Address '1 U 10 Contractor Reg # City St NiN 4p Phone# 273- 5sb 4 Expiration Date ©7 / 1a/ I #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. 3J 2 1 - 54 - �3 r egal Description 1��0�1�� �,c.� '_� `�" 1 a3 #5 Building Square Footage: 1st FI 340 2nd FI 3rd FI Loft Basement # Bedrooms # bathrooms l Deck Other Garage Carport (Circle:Attached or Detached?) #6 Use of building Describe work : New Add Alt Re #7 Type of Job air Other e p YP #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year I/Make Model ,gyp �w (� Length ; f_ Width A-' Serial No. o4-q+o Z�O i� �c.rx2� ¢2���6 3 1 `��1 ce'f" # Bedrooms # Bathrooms I Type of Heat z Qo-�L► "1 Purchase Price$ L 500 #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 t�/ia I Show following on the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Drainage Plan Wells Septic Systems Easements Proposed Improvements Indicate Directional by (N, S, E, W) Name of Side Street Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW 107. APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW I Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Units Fees Showers Fu rn BTU Hot Water Htr _ Heatpumps Laundry Washer _ Vent Systems Sinks _ Spot Vent Fans Floor Drains No. 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 16.75 Auto Fire Sprink Sys 35.00 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 16.75 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 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 FIRS OBTAINING PPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEP MENT. DEPARTMENT. X OWNER X BY DATE _ O . DATE FOR OFFICIAL USE ONLY: Accepted by: - ^1 ' Date: 1 DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: '(-ig-q7 Am Environmental Health: Build' g Plan Review �l Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee Other Other Other Building Valuation: TOTAL FEE