HomeMy WebLinkAboutMIS97-0808 FNDTN - MIS Permit / Conditions - 11/24/1997 M :7-
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CONCRETE MECHANICAL MOBILE HOME
Footin s-Setback n date by Ribbons
date ),,t-z� q;7 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
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date ,I_/_5 by date by
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MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
PLEASE PRINT
#1 Owner Ju,rzz5 Ear , Phone# -i��Ty g Fire District#
Site Address 77/ &2)K4 ST2��7- City S -zx)
Mail Address F O • For 21 0 7
City _I St /�/,Q Zip 619S k
Applicant :7qeZ 5 -'-P,Z-C.E'6c'S Phone# .3,,C6 -/i32!-9E S'9
Applicant Address f O. o,c 2,S__D 7
City Tl�^J St �t ,4 Zip �8��4/
Directions to Site: Z�Tv7� ���.� l / i 77�a/-���'�•�=0�T 7J,� ✓ u/,Q
7'y L-4 T VTiq A) VZx_L 4,gF E LL 0 J �D�}
#2 Parcel No.
Legal Description Ltd f / Z
#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 runoff marsh other
#4 Project Start Date Project Completion Date
#5 Use of Buildiing , R A e,- Describe proposed construction F
`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 CONTRACTORS 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 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 CHANG HALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST
WITHOUT FIRST OBTAINING APPROV)
LF OMTHEBUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
ING DEPART — MENT.
X OWNE X BY
DATE 7 T7 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
FfJR OFFICIAL USE ONLY Accepted by tate
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning `.r APP COND APP HOLD
Ise C f\ 1}(l S
Building « 4,-D O to( �, it j
Fire Marshal
1
Other gwa, (r -
'N
Special Conditions Fees
Permit Fee $ �
Plan Check
Other
Other
State Building Fee
TOTAL DUE $ Sos 5