HomeMy WebLinkAboutMIS5399 and MIS94-00544 - MIS Permit / Conditions EUR
RD E 7 I MIS
JUL 2 5 1994 MASON COUNTY
GENERAL SERNVI§CELLANEOUS PERMIT APPLICATIONS
PLEASE PRINT
426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427 9670
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#1 Owner A astiell Phone# ZXy(,p 411P ST VZFIfe District#s�
Site Address 'i" _Z4&20 041WDwl Ltd- IC City ( RAARTW t1U-Q
Mail Address Staiw1Tr—
City St Zip
Applicant :75JA Ad TL - Phone#
Applicant Address
City St Zip
Directions to Site: W1 t LPL (—a4mAIZ�--
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#2 Parcel No. ZZ /D S - 5 Z - 600 /a
Legal Description IM b5 .`l L_.tA'y i STPer-Tc& l 0
#3 Indicate by cir ling the applicable source if any water is on or adjacent to the property site:
saltwater &ejriver creek stream pond wetland seasonal runoff marsh other
#4 Project Start Date72,3/ CI4 Project Completion Date —7 3 yI 4 �f
#5 Use of Buildiing Describe proposed construction S 1 iCjL—�&4 Lam•
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'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 WASHINGTON AND I AM
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT-
ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERMIT 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
WITHOUTFI I ININ PROVALFR THEBUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
ING DEPAR MENT.
X OWNER X BY
DATE DATE
Show following on the site plan ; , ` , , . J
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Wells
Water Lines Shorelines
Drainage Plan Easements
Septic Systems .Name of Fronting Street Indicate directional by
Proposed Improvements Name of Flanking Street N, S, E, W etc.
PLOT PLAN AREA
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DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
Building
Fire Marshal
Other
Special Conditions Fees
Permit Fee
Plan Check
Other
Other
State Building Fee �3�� �•
TOTAL DUE $ ��•��
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date by
Foundation Walls date by set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING FIRE DEPT.
date Walls
PLUMBING by date by date by
Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date 1 Z— 2 _ by6 {� date by