HomeMy WebLinkAboutBLD93-01343 Mobile Home - BLD Permit / Conditions - 9/21/1993 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P,O, Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date ;'by
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 Attic OTHER
Groundwork
date b 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. III 426 W. Cedar
P.O, Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner Phone# 7 S7
Site Address Fire District #
City k�t St Zip Z
Directions to Job Site
J4!at 0-1 ZWRL4ALI YC46-S 9A C's8n
Owner Mailing Address Isax ?It 3
City U_VP0 W' St V A:k. Zip -
*)-k. Lien/Title Holder to :d "Lav, P0,4href
Address 4/11
City Sty� , Zip
T2 Contractor Name Contractor Reg#
Address loct 1 S (k &1P_"\W00A lu Expiration date City 01r&.Y."I Stec zip°I 36� Phone 31G - 1173
#3 If septic is located on project site, include records .
Connect to Septic?�_ Public Water Supply Well
(If residential, proof of potable water is required)
#4 Parcel No."2 311 - 74 - 00/0O
Legal Description 7Z 10 ()'F Sogy v ( !V
#5 Building Square Footage:
1st Fl Y 2nd F1 3rd Fl Loft Basement
Deck #bedrooms Z #bathrooms I Garage Carport
Garage/Carport: Attached or Detached
Other
f
#6 Use of building Describe work /,-1QV4e
#7 Type of Job: New ✓ Add Alt Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION Model Year Make Model So"I an iv:
Length S� Width _ Serial No.
#Bedrooms #Bathrooms _ Type of Heat H sec-}rim
#9 Any water on Nadjacent to property: saltwater lake
river pond wetland seasonal runoff
other
n
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 Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELO31,
►� �S� f
4C
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
C? �-�
r :umbing Fixtures Fee Mechanical Fixtures
No. Toilets Primary Heat Source (circle type)
Bath Basins Elect/heatpump/other
Bath Tubs
Showers NO. FEE
Hot Water Htr Furn
Laun asher Heat Pumps
Sinks Vent Sys (Central)
Floor Drains Ven of/Whole)
Laundry Basins oilers/Co pressors
Dishwasher A HP
Disposal r ndlin Unit
Urinals cfm.
Other F r Prote tion Systems
Permit Basic Fee
TOTAL PLUMBING $
Other
Gas Outlets .Hookups
Wood/Pellet/Gas Stove
Other
Permit Basic Fee
TOTAL MECHANICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
i THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE _ CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL. FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. ' �L DEPARTMENT.
X OWNER vV X BY
DATE ZIC13 DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
FOR OFFICIAL USE ONLY:'. Accepted by: t Date:
J
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond Hold
Approval
Planning:
Environmental Health:
MT
Building Plan Review: --PWSzt#}. .L Pe-2 rA►" k Spec
Occupancy Group: rAO / c
Fire Marshal: '
Other:
FEES
IlSpecial Conditions: 11 IlSite Inspection I 11
II sua (-rrcb P09- t9�N II I
II 0W_ c.tc.s . L,04 5r -f- Bb II IlBuilding Permit 1 II
w/o .4 peRM(r 1 % II 11 i ii
AT ter -tA*N t!�n1 11 Violation Fee 1 11
it �e4 4- tz " rT-- 11 I I
11 11 11Violation Investigation Fee I 11
II Il I I
1I 11 _ II Plan Check 1 11
II 11 H i H
11 11 II Plumbing Fee I 11
II 11 1 1
II 11 11Mechanical Fee I il
1l 11 ii i ii
11 11 11Woodstove Fee 1 11
II 1l I I
11 11 IlBuilding State Fee 1 11
1� �I I I
IlBuilding Valuation: 11 11 TOTAL I `j I C l
�ON
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42
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06/25 ,98 THU 14: 12 FAX 3604277798 MASON COUNTY BLh 3 _ (�007
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