HomeMy WebLinkAboutMIS93-0546 Cancelled ReRoof - MIS Permit / Conditions - 3/13/1994 MASON COUNTY PERMIT
Mason County Bldg. 111 426 W. Cedar NULL & VOID BYMRATION
P.O. Box 186 Shelton, Washington 98584 DATE IO/Z�bqy
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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 Final
Floors
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 by date by
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MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
'LEASE PRINT
"1 Owner CPC_te_ ��7—C��JO1-� Phone # 4 2(o — Fire District#
Site Address =—, 1 C-T�Atij City
Mail Address Pp, � Z-1
City _"S- nJ St UJA Zip g12RSay
Applicant OV.�t�L—YL Phone#
Applicant Address
City St Zip
Directions to Site: —TL-)2&v RT c>F—t ' AARSnlJ l_k VZZI)AD PAST l_IMk�LCIZ S-TC)
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,;2 Parcel No.
Legal Description i �—(- llCo �DIV1SI oiJ LV LPEV_G I_k0Arr-1(z1G(L
a`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 L �'i 3 Project Completion Date
45 Use of Buildiing _Describe proposed construction —12�0V--
'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-
NAENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM
,ICW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT-
)RDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERMIT IS ISSUED AND
S ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE-
,FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST
PJITHOUT FIRST OBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
NG DEPART rfI T. MENT.
OWNER __._ _. X BY
TE ��7 /�/ /!/G1� 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: Date:
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
Building
Fire Marshal
Other
Special Conditions Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee
TOTAL DUE $