Loading...
HomeMy WebLinkAboutMIS97-0531 - MIS Permit / Conditions - 8/14/1997 7r, IS 7 < < En o 0 00 ol Cl) cn Q � z ::)7 0,N) + 0 (D -00- 00 Ol OD ro 7A 0 CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foupdation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date FRAMING by date by date by 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 by date by 7-1 00 0- CO cN N) 10 Q- Op 00 b c) 00 C: ol :3 C/) :37 cn 4CD CQ 000 CP MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 _EASE PRINT #1 Owner^ rv,2V �� Phone# X f -7 '2/ Fire District#��_ Site Address-22f ZJ �-,y Cf/A /I V City Mail Address City n (f- St 6'A '�4 Zip < S� Applicant 19A"e. Phone# Applicant Address City St Zip Directions to Site: #2 Parcel No. q 2©a - - � Legal Description C Al T/,-,, #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 Project Completion Date #5 Use of Buildiing Describe proposed construction '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 WITHOUT FIRST OBTAINING APO VAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DE PA6 MENT. X OWN X BY DATE 9 /'!/ DATE 3 I 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 Indicate directional by Proposed Improvements Name of Flanking Street N, S, E, W etc. PLOT PLAN AREA IQA OFFICIAL�1SE ONLY AcCep#ed bats XX 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 TOTAL DUE $