HomeMy WebLinkAboutMIS95-0947 - MIS Permit / Conditions - 12/5/1995 TV
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CONCRETE MECHANICAL
Footings Setback MOBILE HOME
date by date by Ribbons
Foundation Walls Gas Piping date b
date by
date by Set Up
INSULATION date b
BG/SLAB Insulation y
date by Floors Edate
FRAMING date by by
date b Walls
PLUMBING
y date by 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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CONCRETE MECHANICAL
Footings Setback MOBILE HOME
date date by Ribbons
by Gas Piping date Foundation Walls b
date date b Set Up
by INSULATION date
BG/SLAB Insulation by
date b Floors E
FRAMING y date by by
date b Walls EE
PLUMBING y date by by
Groundwork Attic HER
Pdate
b date by
WALLBOARD NAILING
by date by
FINAL INSPECTION
by date by
- date
I MIS v
MASON COUNTY
MISCELLANEOUS PERMIT A PPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 9E 84. 427-9670
PLEASE PRINT
#1 Owner �� 4 'Z'� sz �'` - Phone 47_1, q L L Fire District#
Site Address i ` �� � - CityL.�i
Mail Address E,
City St t..�%A Zip 9�`�i✓ }
Applicant `IL ,W .� �5a vv1 Phone# C' ivL� rzL
Applicant Address `� �� z. �,✓�
St Zip
City
Directions to Site: NGnk�`
#2 Parcel No. Z 0 11, ®O D O 6
Legal Description ' c
#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 run ff marsh other
#4 Project Start Date t 4
t Project Completion Date S .
#5 Use of Buildiing e:>� 2�yidti;��s� D ascribe proposed construc on
#�• <�� 3
��•l -�b'ha _
'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 CONTR CTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTI Y 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 FIRSTOBTAINING APPROVAL FROMTHE BUILD- OBTAIN NG APPROVAL FROM THE BUILDING DEPART-
ING DEPARTMENT. MENT.
X OWNER t Z X BY
DATE Z DATE
FF�
how following on the site plan
s Flood Zonestures Fencesacks 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 JOLD
Building
;_;7
Fire Marshal
Other
Special Conditions
Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee
TOTAL DUE $