HomeMy WebLinkAboutMIS94-0784 Foundation - MIS Permit / Conditions - 9/26/1994i
MASON COUNTY
Mason County Bldg. III 426 W. Cedar j
P.O. Box 186 Shelton, Washington 98584
HIS94-0784 PARR I , 01 01 ttlnO0040 PIA l
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.SHELTON—MATLOCK ROAD TO iITTLF E6YPr ROAD TURN I.FFT TO
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{ MT% PP114 e410114 COMP1 IANCF r0 Ai rAc a CON11T7TONs 1s
REQUIRED
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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 OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date��j� p� by J/W date by
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III
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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 y date b
date b y
FRAMING
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
d date by
ate by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
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MASON COUNTY
Mason County Bldg. III 426 W, Cedar
P.O. Box 186 Shelton, Washington 98584
II -
I .
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 OTHER
Groundwork Attic
date by date by
` WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date by date by
00 1 i No. m I J Y'q-J-4�('
14 MASON COUNTY �� O PIL J:A P
BUILDING PERMIT APPLICATION Abar+ .F�zJ
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 v LA,
PLEASE PRINT
#1 Owner D wt Phone#
ddress_ VU 131 4r�m�fi, , Fire District#
City C I /7�m. _ St zel-4 Zip O/T 3r�
Directions to Job Site �ham/
art I�Eat D I f 7u/2 -" A c!'7—
Owner
Mailing Address 1-R O 7 GcJ � ,�•�-
City Z To-� w St t'—)A Zip
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name �.t'2sLg����o.y o-vs�%7��:.�e A.�oc_ Contractor Reg
Address �/3 0 4 G A-- /2 Expiration Dated/�_/
City h o /To-cam St Lu.4 Zip��L Phone# �Ja2ra —_5 4:_
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Conn ct to Sewer System? Name of System
(If re dential, proof of potable water is required) t
4,no/8-75 • 000+v
#4 arcel No. - -
egal Description /c 'q GT ;Z
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement Deck / #bedrooms_/ #bathrooms —/
Garage / Carport / Circle:Attached or Detached?)
Other -:.+R ft. 13' � /C'3
#6 Use of building �*i2&5j Cz,.,�.(,'v -��r S-0Ff!t-c C Describe work, -�
#7 Type of Job: New x Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat
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
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
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
� �� G A � �/
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. ni Fees
_LShowers > Furn BTU
_Hot Water Htr — Heatpumps
_Laundry Washer `Z V*stems 8
Sinks Spot Vent Fans
_Floor Drains No. Boilers/Compressors
_Laundry Basins HP
Dishwasher �_ No. Air Handlin_ 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 $ � . 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 1 00
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 APPR FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPAR NT.
X OWNER X BY
DATE E
FOR OFFICIAL USE ONLY:Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: S 21170 IM141M
Environmental Health:
Building Plan Review
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
p tr 0
Building Permit
Plan Check
Plumbing Fee -�
Mechanical Fee ?j3
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
2 Site Inspection
O SZ7
��.% g�i�S 5�—� Ze Building State Fee
Other
Other
Building Valuation: ( �'— TOTAL FEE