HomeMy WebLinkAboutMIS92-0128 - SPI Inspections - 11/5/1992 MASON COUNTY
Mason County Bldg, 111 426 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 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 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
uu,Ltly� rr,n1Y111 �-lt'rLil.�11V1�
PLEASE PRINT
#1 Owner-[)A L ) 11U F-5 PE i Phone#
Site Address -2 .S 0City St Zi 8 5 7
Directions to Job Si e 4"
Owner Mailing Address ? S D 7 C S Kd J
City S � l�l St Zip rY
Lien/Title Holder
Address
City St Zip
#2 Contractor Name 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
(If residential, proof of potable water may be required)
#4 Parcel No. = �`- � -�S- C�-�--1'(�
Legal Description /-, -'7:
U
#5 Building Square Footage: (existing/proposed)
1st Fl / 2nd Fl / 3rd Fl / Loft /
Basement / Deck ' / #bedrooms_ #bathrooms__
Garage / Carport Z4 X / (Circle: Attached or Detached?)
Other sq ft /
#6 Use of building /�
Describe work
#7 Type of Job: New Add Alt X Repair Demolition
Woodstove Re-Roof Bulkhead Other
#8 MOBILE FOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
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
Nance of Fronting Street Scale:
LDate:
=APPLICANT TO DRAW SITE PLAN BELO
i
s -
kPPLICANT TO DRAW TOPOGRAPHY PROFILE BELO
i
I
I
i
No• Toilets
—Bath Basins Vent Systems X :3 . 00_ _
�
2
Bath Tubs Vent Fans X 3 . 00 _
Showers No. Boilers/Compressors
Hot Water Htr 0-3 HP 6 . 00
Laundry Washer 3-15 HP -- 0�
Sinks 15-30 HP 6 0�
Floor Drains 30-50 HP
Laundry Basins 50 + Hp ��
No. Air Handling Unit
Dishwasher
Disposal <- 10000 cfm. 7. 50
Urinals
> 10000 cfm.
Other
Other
Evap Coolers _
Permit Basic Fee Hoods
-- �TOTAL PLUMING $ Fire Suppression
Domes. Incin.
COmml. Incin.
Medal Fixtures Reloc/Repair _--_
No. Fuel Types f _ Gas Outlets X 2- 00
Furn < 100K BTU _I Woodstove seVLra
Other
Furn >- 100K BTU ----
Furs - Floor 6. 00 Permit Basic Fee
Heat Pumps ��_
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRIICTION
AUTHORIZEDIS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AF`rE'R 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
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT.
DEPARTMENT.
X OWNER �G �c
BY
DATE z X DATE
=turn permit to: Department of General Services
6 W. Cedar/P.O. Box 186, Shelton, PTA 98584
427-9670/1-800-562-5628
FOR OFFICIAL USE ONLY: Accepted by:
Date:
Approved Cox! Hai d
Approval -
Planning: ,
Environmental Health:
Building Plan Review:
Occupancy Group:
Fire Marshall:
Other:
lit FEES
Ilspecial Conditions : 11 11site Inspection ( ((
II 11 11 '!
II 11 IlBuilding Permit ( ((
11 liviolation Fee 1 ((
1I 11 (I 'I
II 11 11Violation Investigation Fee 1 ((
11 11 II 'I
ll II II Plan Check ( I(
II Ii 'I
II 11 II Plumbing Fee I II
(i II H 'I
II 11 11Mechanical Fee 1 II
ll 11 I i
1f 11 Ilwoodstove Fee I II
II II R
11 11 IlBuilding State Fee 1 I1
I` '1 11 it
IlBuilding Valuation: 11 II TOTAL
f j� II