HomeMy WebLinkAboutMIS98-0396 - MIS Permit / Conditions - 7/31/1998 ch
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons Y'
irate by Gas Piping date by
(Foundation Walls date by Set Up
date by INSULATION date by
BC/SLAB Insulation Floors lFinal
date by date by date by
FRAMING Walls —--) FIRE DEPT.
date by date by idate' �y by
PLUMBING Attic OTHER Groundwork
date by date by i
D.W.V. - WALLBOARD NAILING
date by date by
Water Lire FINAL INSPECTION
date /by date A by date by
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•FORM MUST BE COMPLETED IN INK �21�-Y �
PLEASE PRESS HARD PERMIT NO.: MIS
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275•4467 Elma 360 482-5269 Seattle 206 464-6968
APPLIC INFORM " ION CONTRACTOR INFORMATION
Owner Contractor Name po;zD dc'm 4'S
Mailing Address f t C-H iC C-R K. Mailing Address
City. S to JA- Zip Code 'IB5-154' City State Zip Code
Phone(__) 4Z'1-q " (Other Ph.( Ph.( Other Ph.(
Lien/Title Holder Contractor Reg. #
Address Expiration
PARCEL INFORMATION-12 digit Parcel N / / Fire District
Legal Description -
Site Address(include street namd and city
Directions to site:
Will timber be cut and sold in parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe proposed construction IN S-1-4Lt hr lcv w r Ij ojS
SHORELINE PROJECTS New Replacement Repair Expansion
Bulkhead Material (concrete, rock, wood, etc.) Length Height
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT.
NOTICE: THIS PERMIT BECOMES NULL 8•VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-[certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the
ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued
will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall
first obtaining approval. be made without first obtaining approval.
X E' Date� �y X Date
r
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department 7-31`s
Occ G rp Z 3 Type of Const. W Sr (?ON D 1 T"l 6^J
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
FEES
Building Permit Fee .ZI, v0 Site Inspection
Plan Review Fee Other
UFC Plan Review Fee Other ST, "Ftt u• S�'
Violation Fee Pre-Paid at Submittal ( )
7 : ,, r f. � .' TOTAL FEES - s
{.. 2 S
•.v�:..v+f�'sw vv�'. ..Div}z. j..v�'.>.. .iY .+ • v'•. •'• •..
v VORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name AQxA a ig. J [ � PARCEL NUMBER 7
SHOW THE F OWING ON SITE PLAN Show Direction 6y indicationg N, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property lined , I E-adjacent property line
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adjacent property line-� ti �'� I <—adjacent property line
SAMPLE SITE PLAN
adjacent property line-> ,E__ 3io� _ _ _ E-adjacent property line
I D 30' rRE_SC_RvE I a 7R L _]�PC7L
CREEK AL. HOM b
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adjacent property line- ; A�. \i E-adjacent propert�line
TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE
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Signature Date