HomeMy WebLinkAboutMIS94-00260 Final ReRoof - MIS Permit / Conditions - 5/13/1994 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 WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INS ECTIO
date by date z_) I- t- by 1 - date by i
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
MIS
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
• 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670
PLEASE PRINT
#1 Owner NA A,nn /C.Eo-r Phone# = 2 Fire District#
Site Address City
Mail Address
City c5h� St Zip �y
Applicant !kT L 6� � A606ZIS le , Phone#
Applicant Address r
City ` St Zip
Directions to Site: �,��,� (I Al AC44t6e
#2 Parcel No. `1-���- R- ail 6 60
Legal Description T�� f iaGGF�-Q ?��d Ct :;1 —
#3 Indicate by circling the applicaple source if any water is on or adjacent to the property site:
saltwater lake river,, ree tream pond wetland seasonal runoff marsh other
#4 Project Start Date c��Zf Project Completion Date
#5 Use of Buildiing ��.i Describe proposed construction
'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-
MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT-
ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERMIT IS ISSUED AND
IS 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 S ALL BE MADE WITHOUT FIRST
WITHOUT FIRSTOBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROV FROM THE BUILDING DEPART-
ING DEPARTMENT. MENT.
K OWNER X BY
)ATE 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 $