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HomeMy WebLinkAboutBLD94-01016 Cancelled Mobile Home Replacement - BLD Application - 7/8/1994I � � /-jam Permit No. D MAtON C LINTY '/``tom OILDING PERMIT APPLICATION J U t - 8 tW W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 ICES11Ar► '-- - Phone# Address //il/ C_0&':75 Fire District# vZ City 7'a St[.y/,1 Zip Directions to Job Site r&m ,etc &,SAT 94 Z=kr.,'t Tc�fic�vA �� Ta-4.,;t 12 Twa Z&C. o//:� �L�c d�, To "'7&M Snnrorr Q e 7 ZZy� Owner Mailing Address .same- ca-5; City St Zip Lien/Title Holder Z21A-Porgy -S' o,5 Address S7© i(/cw,F,iE'k kd City a.-I Sty Zip TeAcke- #2 Contractor Name : ' S Con.3'ru, Contractor Reg#AL,B Rik-- t* ��,S•�.L Address ty ,,v 303 Y 01 1,ev E Expiration Date City Pin t St 1014 Zip f ftXT Phone# #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) #4 el No. egal Description #5 Building Square Footage: (existing/proposed) 1st FI /?LJ/ 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq. ft. / #6 Use of building Aye,5,' n c Describe work ut If -ems r`s '1 Gu #7 Type of Job: New�_'Add Alt epair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year U7 Makek'e r- Model wi X-.z.ksAeR-1 Length 6_Width�Z*Serial No.C?9'4oZ75'09X u- # Bedrooms 3 # Bathrooms Type of Heat Tftee Rik c_4x70'c_ Purchase Price $ cOcxOy Z� #9 Indicate by circling the applicable source if al3w 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 a 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 Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW 9772e c-� c-(:Z- APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW �D w�7-z-- Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Uaila Fees Showers _ Furn BTU Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems Sinks Spot Vent Fans Floor Drains No. Bo i liers/Co m press r Laundry Basins — H Dishwasher No. Air HandlinILL ni _Disposal cfm# Urinals No. Fire Protecti n Systems Other _ Auto. Fir e larm Sys 50.00 Fixed ire Supp. Sys 50.00 Permit B sic Fee 15.00 Auto ire Sprink Sys 25.00 TOTAL PLUMBING $ o. r s Outlets ood, Ga 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 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 �-= - nl7' DATE tl FOROFFICIAL USE ONLY:Accepted by; Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: I Y)11rYl Environmental Health: Building Plan 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 1 Building Valuation: TOTAL FEE 4 -S V) raaw err. �IIIOY rw I 1 1 I � 1 I !it ur�w C w � 1 1 i rwrre r b6 ram' Ll i 65