HomeMy WebLinkAboutMIS96-0564 REROOF - MIS Permit / Conditions - 8/20/1996 Pill
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
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
Attic
Groundwork date by
date by WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date by date by
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
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 Attic OTHER
Groundwork date by
date by WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date by date by
MISq LP 'D
MASON COUNT
MISCELLANEOUS PERMI APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, W i98584. 427-9670
PLEASE PRINT
#1 Owner - l ,S °� Phone ,(z,_5_4 7'7 Fire District#
Site Address wit/ City,:2,�i,r/
Mail Address b, I
City St Zip
Applicant Phone #
Applicant Address
City St Zip
Directions to Site:
U_-cod lf��,, qu U_ ,U�
#2 Parcel No. ��
Legal Description (J_) �Qt `
#3 Indicate by circling the applicable source if any water is on or adjace it to the property site:
saltwater lake river creek stream pond wetland seasonal ruiloff marsh other
#4 Project Start Date (h-L� Project C mpletion Date
#5 Use of Buildiing I escribe 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 CONTR CTORS 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 TRACT R 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 I'NG APPROVAL FROM THE BUILDING DEPART-
ING DEPARTMENT- —, MENT.
X OWNT= 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
Building
Fire Marshal
Other
Special Conditions Fees n
Permit Fee $ n(�
Plan Check 'y
Other
Other
State Building Fee
TOTAL DUE $ 650