HomeMy WebLinkAboutBLD96-0923 Cancelled MFG Home - BLD Application - 7/25/1996 Permit No. �\p�
MASON COUNTY
BUILDING PERMIT APPLICATION Q�
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
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#1 Ow er -� Lei h `��1 Phone#&i'd
ite Addr s /� / - Fire istrict#
ity /^ �-' ! L? , St zip
S
irections to Job Site �i/ T / l l l T �fC� S- l�Z /�Adv ACO
Owner Mailing Address
City f� St �`" Zip
Lien/Title Holder
Address
City St zipqq337
#2 Contractor Name t/� G' L- Contractor Reg Address Expiration Expiration Date / e /�'7
City St `Zip Phone# a s 7; 7"
#3 If septic is located on project site, ' clude ds.
Connect to Septic? ✓Public ter Su ly Well
Connect to Sewer System? a of ystem �G�
(If residential, proof of potable water is required)
r�l, �0v4e /233CD S-0 - 00020
rceI No. i V - T
Legal Description w� S�
-�p�d!s— Coil 0 44-3 Te.2 CD
#5 Building Square Footage: (bxisting/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck #bedroo / #bathrooms /
Garage / Ca port / :Attached o ched?)
Other sq. ft. /
#6 Use of building Describe work
#7 Type of Job: New Add Alt Repair Other ✓� Wu
�L C
#8 MOBILE/MANUFACTURED HOME INFORMA N r
N
Model Ye Make Model,
h
Length Width Serial No.�iC
# Bedrooms # Bathrooms_Type of Heat
Purchase Price$ /�4 VV 0
Oil
#9 Indicate b circling the applicable source if an water is on or adjacent to subjectproperty: n 0
Y 9 pP Y J 1
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 b N, S, E, W)
Name of Flanking Street y
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
!� 106 c
!
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Egg 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 Basin HP
Dishwasher No. Air H ndlin ni
Disposal cfm#
Urinals No. Fire Prote,6tion Systems
Oth Auto ire Alarm Sys 50,00
axed 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
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 THER ITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FI OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE B I ING DEP E T. DEPARTMENT.
X OW X BY
DATE Z6 DATE
FOR OFFICIAL USE ONLY: Accepted by: �' L - r �`� Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
l �
Environmental Health:
Building PI Review
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE