HomeMy WebLinkAboutBLD98-00452 Cancelled Mobile Home - BLD Application - 5/1/1998 DEPARTMENTAL REVIEW [ Permit No. JQO��s
FOR OFFICE USE ONLY I_., MASON COUNTY
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�,t�►`r _ ` 7, BUILDING PERMIT APPLICATION T ��
Approved Approval p Hold 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670 �
Approval
TT ''� ��`:'`: (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
Planning: PLEA8 PRIAtT Cluj
#1 Owner Ct Oki Phone# Ff 9-5 y 27
Site Address e e 0 a d Fire District#
city St S f .Zip 9 8 S 2 g
Directions to Job Site T h i t k kd
Environmental Health:
Owner Mailing Address
city StQRSH Zip9 V 34, 7
Lien/Title Holder g r � ct v\ 0 r- n o d c�
Building Plan Review A/0 e'o fl/CL!/.t�� Address Li0' 7 S Cetcrj5v vi Ln
City P _ _ f C_ kArd St 4)A N.zip 9 $3,40
r'f7e7C5: iooa /0i1 /0/a .�007. 50/3,�O�c soao L 1
��' / #2 r QC ntractor Name �- - _ C V h S ✓V C I I D Vk UBI # (o O 16�12 7 3
.\ dress P. (0 -7 _ Contractor Reg# A('e C O Ir i o yy 6 6
Occupancy Group: Type of Const: 0� '
ity ,m , St Zips Phone;!► _Expiration Date 1 a /LI
Fire Marshal: #3 If septic is located on project site, include records i°� tv m5I J1+ *C e(1 W (+' V\5O a a
Connect to Septic? V Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
Other: #4 Parcel No. Z Z o—L - -7 S
Legal Description S ee S Pe V1S i 2
#5 Bu' ' g Square Footage:
Special Conditions: FEES 1st FI 2nd FI 3rd FI Loft Basement
# Bedrooms # bathrooms Deck Other
Building Permit Ca (Circle: Attached or Detached?)
Plan Check
Plumbing Fee #6 Use of building Ea VV\ I L� Y IO M C- Describe work m 0n
Mechanical Fee
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Wood/Gas/Pellet Stove #7 Type of Job: New V_Add Alt Repair Other
Violation Fee
#8 MOBILE/MANUFACTURED HOME INFORMATION
Site Inspection Model Year 1 a815 MakeModel 'yLfsa-
Building State Fee Lengthq_Width a 6• (o Serial No. I �I J��P & D 5T 0 2-95
# Bedrooms 3 # Bathrooms
Other _Type of Heat e r LJ f j G Al
Other Purchase Price$ a 4Z, U 0 Z)
Other #9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
Building Valuation: TOTAL FEE River Pond Creek Stream Wetland Lak Mars Saltwater Seasonal Runoff Other
Plumbing Fixtures ($3 45 eachl Fee Mechanical Fixtures ($7.00 each)
t ;
No. _Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Q
Bath Tubs No Units Fees
_ howers _ urn BTU
s —Hot Water Htr — H tpumps
Laundry Washer — Vent ystems
-,zO �, Sinks Spot Vent Fans
—Floor Drains No. Boilers/Compressors
—Laundry Basi — HP
TREE —Dishwasher No. Air Handling Units
z Dis os cfm#
,. __, — p —
+ 5Ppi1 L
f "��--- —Uri Is No. Fire Protecti S ste s
\" they Auto. Fire Alarm Sys 50.00
Ld �� — Fixed Fire Supp. Sys 50.00
Permit Basic Fee 17.25 — Auto�re Sprink Sys 35.00
� TOTAL PLUMBING $ No. Ot r
IVFWp w
as Outlets
50 Wood, Gas, Pellet Stove
- -- --- \ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF _
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 17.25
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
IMoV 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 DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
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