HomeMy WebLinkAboutMIS93-00101 Insulation and Sheetrock - MIS Permit / Conditions - 6/22/1993 MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by 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 OTHER
Groundwork Attic
date by date by
D.W.V. WALLBO_ --
date by by
Water Line FINAL INSPECTION
date by date by date by
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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
PLEASE PRINT
Owner �Jf �l J2 Phone# ,>o ` �� (1,'.2 / 0
Site Addre s 'V� '� Fire District #S
City /e '/ St zip S"
Directions to Job Site Sy,-2 C/ `hA,-1�14
c e- ep
v d 1')-e A'^ ,q 1- C/loP 'ram
/"` av;�'- e
Owner Mailing dres �/
City t Zip
Lien/Title Holder /�� wP A��r
Address_ Z- /54" _
City TT�- St Zip
�e lls o t'`1✓'
Contractor Name Contractor Reg#
Address Expiration date
City St Zip Phone
#3 If septic is located on project site, include records .
Connect to Septic? Public Water Supply Well
(If residential, proof of potable water is required)
4 Parcel No. 32' 1 � 6 v3 // d Y
Legal Description
Building Square Footage:
lU 1st F1 2nd F1 3rd F1 Loft Basement
Deck #bedrooms #bathrooms Garage Carport
Garage/Carport: Attached or Detached
Other ,�
6 Use��f building_ S�"" �" S7�VJ",' Describe work
#7 Type of Job: New Add Al Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME INFO ION
Model Year Mak Model
Length Seri o.
#Bedrooms #Bathrooms Type of He
#9 Any water on or at ttN-�roperty: saltwater lake
river pondtand seasonal runoff
other
DEPARTMENTAL. REVIEW
FOR OFFICE US$ CMMY
• Approved Cond Hold
Approval
Planning:
Environmental Health:
Building Plan Review: Povrvc, - -b ir,�,,,�-kjyzkk q_g.cj}
►W2L -to A7-A �w�Occupancy Group:
Group:
Fire Marshal :
Other:
FEES or tf
IlSpecial Conditions: 11 Ilsite Inspection
II 11 I I
II 11 IlBuilding Permit
it II I'
II 11 Ilviolation Fee I II
II 11 I I
II 11 Ilviolation Investigation Fee I II
II Il I I
If II IlPlan Check
II 11 I' t ►I
II 11 Il Plumbing Fee I II
II II I I
1l 11 11Mechanical Fee I 1l
II 11 I I
11 11 IlWoodstove Fee I II
it II I I
11 11 IlBuilding State Fee I 11
I
11Building Valuation: 11 11 TOTAL I`yg 11
�� 11 if it
'Plumbing Fixtures Fee Mechanical Fixtures
No. Toilets Primary Heat Source (circle type)
Bath Basins Elect/heatpump/other
Bath Tubs
Showers NO. FEE
Hot Water Htr Furn
Laundry Washer Heat Pumps
Sinks Vent Sys (Central)
Floor Drains Vent Fans spot/Whole)
Laundry Basins �Boi s/Compressors
Dishwasher, HP
Disposal Air Handling Unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee
TOTAL PLUMBING $
Other
Gas Ou ts .Hookups
Wood//Pei etiQas Stove
Other
Permit Basic Fee
TOTAL MECHANICAL $
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT / CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. ��,�//� DEPARTMENT.
X OWNER G�(/L�� .. � X BY
DATE �� , r� DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
.
F,QR ' .Pic 'Usz ONLY: Accepted by: Date:
Show following on the site plan
Lot bimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO