HomeMy WebLinkAboutMIS93-0289 Foundation - MIS Permit / Conditions - 6/24/1993 v zv A 'o a C, z 3
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CONCRETE /7'`r MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date G-�- �% by Gas Piping date by
Foundation Walls date by Set Up
date - 3 - `J� by /-- I G 12 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 Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
nr�, tJ csiQr e---, n
IMIS
MASON COUNTY 141I S 3_6Z97
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584.427-9670
PLEASE PRINT
#1 Owner auFll )A'a w" e, 0 _ Phone# 7vC 75- e1o3? Fire District#
Site Address HJ < . ercjr•a�4 4 A� RefJKsz City 941 t
Mail Address o7 0 4,.'— AwY
City WA rY eS 2 c St Zip
Applicant z104 Phone# 2�(0 - G35
Applicant Address
City f St Zip
Directions to Site:N �1� ( e ( �� 19"4 's. � -
2t a— `e— J of reaol
#2 Parcel No. 2 301571
Legal Description L o a- i3 S L P 14 1 q 7 2
I
#3 Indicate by circling the applicable source if any water is on or adjacent to the property site:
saltwater lake river creek stream pond wetland seasonal runoff marsh other
#4 Project Start Date ( 36,- 3 Project Completion Date
#5 Use of Buildiing rest'-6 Describe proposed construction
i
'Depending upon the type of permit,a floor plan and plot plan may be required.
`This permit is valid for 180 days from the date of issuance.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED CON-
MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WAS INGTON AND I AM
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OFTHE ORDINANCE REQUIREMENTS REGULAT-
ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PEF MIT IS ISSUED AND
IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE-
FORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST
WITHOUTFIRSTOB ININGAPPROVAL FROMTHE BUILD- OBTAINING APPROVAL FROM THE UILDING DEPART-
ING DEPARTME, T MENT.
1
X OWNER X BY
DATE DATE
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Wells
Water Lines Shorelines
Drainage Plan Easements
Septic Systems .Name of Fronting Street ate directional by
Proposed Improvements Name of Flanking Street N, S, E, W etc.
PLOT PLAN AREA '4
I h �l�•✓\ f
(9v lcd. he 9 (2 �
/, s js- �
41
CNCC
'�rTE
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b
FOR OFFICIAL USE ONLY:Accepted by.. F` irate .
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
Building s*-s
Fire Marshal
Other
Special Conditions Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee
TOTAL DUE $