HomeMy WebLinkAboutBLD93-1068 Final Change Position of Mobile Home - BLD Permit / Conditions - 7/27/1993 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 c'! / S b c�
Foundation Walls date by Set Up
date by INSULATION date 674-� r-27- Sy by C
BG/SLAB Insulation Floors Final
date by date by date / 1 L 7- 5%y L J
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING _J
date by date by
Water Line [date
INAL INSPECTION
date by by date by
MASON COUNTY
Mason County Bldg, 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 �q r
PLEASE PRINT
#1 Owner e. Phone#
Site Address C f Fire Distr ct# o
City Sty _ Zip
Directions to fob Site /
l/
Owner Mailing Address A0 �&z 1 2�Z
City O St_LG,. Zip
Lien/Title Holder
Address 4/0 U '
City St cq. Zip fta�-a 1:✓
#2 Contractor Name �S'��� ) Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic?__,K _Public Water Supply A Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. 2 13 J i - Q - UG 0 G/
Legal Description Cc, /1� c &f P A
#5 Building Square Footage: (existing/proposed)
list FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq.ft. /
WIVP
#6 Use of building fie-Ls ?/Ped,.Q Describe work Aw
#7 Type of Job: New Add Alt Repair O D�
#8 MOBILE/MANUFACTURED HOMY INFORMATI N G, 0'7 Model Year_ Make Model j�N � 5J
Lengthy Width 12 Serial No. Z
# Bedrooms #Bathrooms _Type of Heat ,c7/ rc • S'
Purchase Price$
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property: l' /
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other /V
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
II
I / N
N
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
o o(awnS Zo
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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
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $
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 -1�e - y'J DATE
FOR OFFICIAL USE ONLY: Accepted by: � C Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: S" 61LhlMUW1 Sl as NOLA
Environmental Health:
Building Plan Revie� �/ 7�
Occupancy Group: Type of Const:
Fire Marshal:
Other:
FEES
Special Conditions:
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