HomeMy WebLinkAboutMIS93-00387 Cancelled Pole Sign - MIS Permit / Conditions - 10/15/1997 MASON COUNTY PERMIT
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Mason County Bldg, 111 426 W. Cedar NULL 01D BY EXPIRATION
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P.O.O. Box 186 Shelton, Washington 98584 DATE 10 /5/9 -BY
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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 by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date b 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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&AL"ev=v TIRE CENTERS, INC.
Permit No.
MASON COUNTY
JUL 131993 BUILDING PERMIT APPLICATION ,1)
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PR T AA\\
#1 Owner 1y P --nRE Phone#
Site Address Z5 `�Iuy_ Fire District#
City VJP% , St Zip
Directions to Job Site
t�k -n17 r-zz
Owner Mailing Address �2 CFuz� A6�i 2-
City t A 6 �Si :RN sr, `moo C1,CWflP0 S�A Zip
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name C Contractor Reg#AA)�!"50
Address , 'E� c su�'-T\ZZ' Expiration Date_/
City St Zip Phone# 373 Coa\S
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well �\
Connect to Sewer System? Name of System ' v�
(If residential, proof of potable water is required)
#4 Parcel No. 1 A 5 3 2- -5_-1)(W2-'�lt
Legal Description Tract "D" of short plat #1226 as recorded Jan 14 83 under Auditor Fi 1e
#410984 & being a portion of tract 15 of Sam B. Theler's home & garden tracts, as recorded
#5 wilding quare �ookget��xi ir�g/prop'oseed�ords of Mason County, WA.
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. / t
#6 Use of building —"�Tvz (24� 2 Describe work Sl
- � Nl�zl 2 R
#7 Type of Job: New ✓\ Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model �1
Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat J U L 211993
Purchase Price$
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property: 3ENERAL SERVICES
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
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
5,,iFr
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
_Hot Water Htr Heatpumps
Laundry Washer _ Vent Systems
_Sinks _ Spot Vent Fans
_Floor Drains No. 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 FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY 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 OFTHE 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 DEPARTMENT. DEPAR NT.
X OWNER X BY
DATE DATE
I
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: y
Environmental Health:
Building Plan Review
Occupancy Group: Type 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