HomeMy WebLinkAboutMIS98-0180 - MIS Permit / Conditions - 4/3/1998 jp. I.,
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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 FRAMING by date by date by
Walls FIRE DEPT.
date PLUMBING by date by date by
Attic OTHER
Groundwork
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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MASON COUNTY MIS
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
(Calling From: Seattle 464-6968, Belfair 75-4467, Elma 482-5269
PLEASE PRINT ' e r
Owner �J Phone# /Fire District#
Site Address oh, i( r.7O✓'� City
Mail Address
City '5A St S Zip
Applicant Phone#
Applicant Address
City St Zip
Contractor Name 'r 10. r -COAor'5 km ivir UBI#
Address Contractor Reg #
City (, (' b St W11 Zip 8 Phone# Expiration Date
ections to Site:
#3 Parcel No. 7w
Legal Description : �
#4 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
#5 Project Start Date _ Project Completion Date
#6 Use of iing De cribe 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 CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFYTHAT I AM ACURRENTLY REGISTERED CONTRACTOR IN THE
CONTRACTORS REGISTRATION LAW RCW 18.27,AND AM AWARE OF STATE OF WVASHINGTON AND I AM AWARE OF THE ORDINANCE RE-
THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS QUIREMENTS REGULATING THE WORK FOR WHICH THE PERMIT IS
PERMIT IS ISSUED AND THAT ALLWORK DONE WILL BE IN CONFORM- ISSUED AND ALLWORK DONEWILL BE IN CONFORMANCE THEREWITH.
ANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. FROM THE UILDING DEPARTMENT.
X OWNER �\f� 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:, pate
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
Buil 'ng .5JEO SAU6W"I��
Fire Marshal
Other
Special Conditions Fees 0
Permit Fee $
Plan Check
Other 1
Other
State Building Fee _
TOTAL DUE
5 -7 7
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:.OL Y M PJ A WA 9 51. 2
SIGNATURE
ISSUED By DEPART NT OF LABOR AND 16USTRIeS