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HomeMy WebLinkAboutMIS95-0210 - MIS Permit / Conditions - 4/3/1995 z > > ✓ z f.. r- 'S A It 10 z Zr > x n 00 O - :3 z co--:t V^1 Q z O N �IINcn ND 10 00 Ol OD -fA z7lil� > 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 b PLUMBING date by Y Groundwork Attic OTHER date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECT N date by date by date by � � I z 0 Of" 011 M m r, C: --i r > > -n M C � tr �pl m z rrs z o i:: 0 = o x 0 00 M 11 c � z ol :3 Cl) > > :T ,< I's CD :3 Q— 0 0- m z n, > > < (D 10 Q- C/ 00 C) z Ol 00 -0 a z rn :z Z7 -0 7- 1� 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 lil FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic d date by ate by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by ------- - MIS MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 9 84. 427-9670 PLEASE PRINT #1 Owner Te M-g 4) k ::Pe je IC<T Phone# Fire District#�_ Site Address Z© r �. " City S �LL Mail Address City St Zip_ �z Applicant Phone# Applicant Address City St Zip Directions to Site: J:(;114)u Lkk Ell V—Y'l lze 1� #2 Parcel No.2fI �9_ 0 0O N 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 runo i marsh other #4 Project Start Date Project Co letion Date � _5— #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 CONTRA TORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIF 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 OFTHE ORDINANCE REQUIREMENTS REGULAT- ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE ORK FOR WHICH THE PERMIT IS ISSUED AND IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WO DONE WILL BE IN CONFORMANCE THERE- FORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITH. N CHANGES SHALL BE MADE WITHOUT FIRST WITHOUT FIRSTOBTAINING APPROVAL FROM THE BUILD- OBTAINI G APPROVAL FROM THE BUILDING DEPART- ING DEPARTMENT. MENT. X OWNER X BY DATE `���y`S� 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:,, pate'; f ' 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 $