HomeMy WebLinkAboutMIS94-0341 - MIS Permit / Conditions - 6/1/1994 77
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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 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 - ��� 'vIL-�!
date by � 2�f'_ �G� by ✓ date by
MIS
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 9 584. 427-9670
PLEASE PRINT
#1 Owner A76 c% /s Phone#_4 o - -V G - zi_3 S-1,4 Fire District#_1L
Site Address // City s 4 e
Mail Address
City / n -, St C.3 a Zip
Applicant Phone#
Applicant Address �--•- �—
City St — Zip
Directions to Site: "-p. �`—
a...� _ L
#2 Parcel No. - _-
Legal Description
#3 Indicate by circling the applicable source if any water is on or adjacent the property site:
saltwater lake river creek stream pond wetland seasonal runof marsh other
#4 Project Start Date Project Completion Date sl
#5 Use of Buildiing Aa-•-+--� De cribe proposed construction t�Je�o
*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 THATI 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 O 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 FIRSTOBTAINING APPROVAL FROMTHE BUILD- OBTAININ APPROVAL FROM THE BUILDING DEPART-
ING DEPARTME T. MENT.
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 Indicate directional by
Proposed Improvements Name of Flanking Street N, S, E, W etc.
PLOT PLAN AREA
FOR OFFICIAL USE ONLY:Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
I
Building
Fire Marshal
Other
Special Conditions Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee ,
TOTAL DUE $