HomeMy WebLinkAboutMIS94-0012 Replace Old Sign - MIS Permit / Conditions - 3/27/1994 MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by �—-"J Gas Piping date by
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
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date !Z7 date by
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 ��A P
PLEASE PRINT
#1 Owner ,s e CTL I r- d vvn WL t4 K 1 �V I D�S f L 1ru tolPhone# L e6) 7s--6 6 3 1
Site Address 3 3 d 6 /�r`v/L wl I R - Se f WA Fire District# .21-11
City 161/-7Pct. r UJ A St Zip SS' :2�
Directions to Job Site ' 7- i e-4 o- Y-- P c
Owner Mailing Address 4 166
City /Se Arg i r- St Zip r�
Lien/Title Holder 1,44
Address
Clty _ St N11 Zip
#2 Contractor Name Contractor Reg#'t,44
Address Expiration Date Al
City St — A'1V
�_Zip Phone#
#3 If septic is located on roject site, include records.rV�
ptic?2 Connect to Se Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No.
Legal Description 7/-"i l� c'f!T .5�� �P� , l - �S 14 L&7 qz,J
#5 Building Sgpare Footage: (existing/proposed)
1st FI 2nd FI �� 3rd FI_ Z1 / Loft/
Basement Deck #bedrooms ,-��� / #bathrooms
Garage /j/ Carport / (Circle: Attached or Detached?)
Other sq.ft.�/
c;
#6 Use of building &le!�'- Describe work f���ca
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year ./V Make Model /V
Length_ Width al No.
# Bedrooms # a rooms Type of Heat
Purchase Price$
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other //
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Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
10
i
n
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee �� Mechanical Fixtures ($6 each
kq
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. Units Eggs
Showers Furn BTU
_Hot Water Htr Heatpumps
Laundry Washer _ Vent Systems
i
_Sinks Spot Vent Fans
_Floor Drains . Boilers/Compressors
_Laundry Basins HP
_Dishwasher No. Air Handling Units
Disposal _ cfm#
Urinals No. Fire Protection Systems
_Other _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ No. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT dFOM THE REQUIRE- I CERTIFY THAT I AM A Co
R TLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING D PARTMENT. p27c5'�I>�� DEPARTMENT.
X OWNE % G�Lf X BY
DATE Q DATE
[FOR OFFICIAL USE ONLY: Accepted by: Date:
i
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: rd � 4-C s-'
IJ
Environmental Health:
Building Plan Review rDv �
ozy+
Occupancy Group r ype of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other.
Other
Building Valuation: TOTAL FEE
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