HomeMy WebLinkAboutMIS97-0405 REROOF - MIS Permit / Conditions - 7/3/1997 _. .e 25— ,
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CONCRETE MECHANICAL MOBILE HOME '
Footirrgs-Setback date by Ribbons
date by Gas Piping date b j
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 by date by
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MASON COUNTY MIS
MISCELLANEOUS PERMIT PPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 9 11584.427-9670
PLEASE PRINT /�` �
#1 Owner l ',VLCtr Phone # o� `-a Fire District#�_
Site Address tA? `3'�,2 ID UG-Vt6 Jq cc-42or t City14
Mail Address PC 6
city VUZ St Zip
Applicant Phone#
Applicant Address F If
City St Zip
Directions to Site: ' il" C' r r e J (0
#2 Parcel No.`19/ W�4_) - _- �C)
Legal Description `j- 2, C SE V �
#3 Indicate by circling the applicable source if any water is on or adjacent to the property site:
saltwater lake river creek streams pond wetland seasonal runoff marsh other
#4 Project Start Date �' 7 7 Project Completion Date
#5 Use of Buildiing S 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 CONTRAC ORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY: HAT I AM A R' CURRENTLY REGISTERED CON-
MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTO N THE STATE OF WA HINGTON AND I AM
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE O HE ORDINANCE REQUIREMENTS REGULAT-
ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE RK FOR WHICH THE PERMIT IS ISSUED AND
IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WOR DONE WILL BE IN CONFORMANCE THERE-
FORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST
WITHOUT FIRSTOBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
ING DEPARTMENT. MENT.
X OWNER ` �— X BY
DATE `j �2 :2 DATE
i
Show following on the site plan
9
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
7Fi QFICIAL USE ONLY;Accep#ed by: date. ......
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP H OLD
Building CMG 11�.hti ��
Fire Marshal
Other
Special Conditions Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee
TOTAL DUE $
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