HomeMy WebLinkAboutBLD95-01232 Cancelled Mobile Home - BLD Application - 8/18/1995 14 7 *-�T Z c,F SV✓ I r
2 IKA
0
� fi
Permit No. gid qy-1 a 3A
MASON COUNTY q
BUILDING PERMIT APPLICATION ��
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1,oner �Z'� 1 h��7 Phone# `< � 2 -Address , G j') Ct-. Dcj Fire District#
y St (.( o- Zip
Directions to Job Site S �j- to rz o
0 J e L gEEt
Owner Mailing Address C) tS < 15�
City BE�= �I/Z- St tAL0 Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name , Qd k n6 65 CCHTJ2Q--pT012--S:, Contractor Reg#AQUA BOG* -.
Address Expiration Date,_/ 2S/5s0
City St Zip Phone#?Olo -87- v7449
#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)
# Parcel Nol2311 -�_- 0C)OZO
Legal Description TYIT 2 o OF Sty I�, Tc1w+�23 1�C�1(L �hC?
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
X
#6 Use of building mO(�>L Qmt L Describe work
#7 Type of Job: New Add Alt Repair Other C�
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Lim Model Ll 13 �
Length Width Serial No.0c�Q'711(�4'>'(U
# Bedrooms ":!:� #Bathrooms 2_ Type of Heat et
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 Indicate Directional by (N, S, E, W)
Name of Flanking Street
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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. Units Fees
Showers Furn 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 15.00 _ Auto Fire Sprink Sys 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 9PTA PP AL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPA E
�+N
X OWNER X BY
DATE DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: rnm5
Environmental Health:
Building Plan Review IVY 0L �r� /'►?� �, Sprc-S �osT AAA_ � �
Occupancy Group-.,;q Type of Const: 1W4N14k:i4e'7-ciPe ) 1-101'17Ar.
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit 100-
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee 4 - 5-0
Other jqjd re�r) 5, o0
Other P) LC (1IZE�LfClr5� ri'-t /yz
Building Valuation: TOTAL FEE