HomeMy WebLinkAboutMIS93-0155 Cancelled Storage - MIS Permit / Conditions - 10/23/1997 -----------------
MASON COUNTY PERMIT
Mason County Bldg. 111 426 W. Cedar NULL v rm iD By EvATION
P.O. Box 186 Shelton, Washington 98584 DATE 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 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
I
MASON COUNTY
Mason County Bldg. 111 426 W, Cedar
P.O. Box 186 Shelton, Washington 98584
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J Permit No�rJ��TVl55J
1 MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner Phone#
Site A d ess Fire District #
city'L St - Zip
Directions to Job Site
Owner Mailing Address
City St Zip
Lien/Title Holder
Address
City St Zip
#2 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. - ' y
s 3c
Legal Description q! E(PQ
#5 Building Square Footage: •f ��0
1st F1 2nd F1 3rd F1 Loft Basement
Deck #bedrooms #bathrooms Garage Carport
Garage/Carport: Attached or Detached
Other
Use of building 1 O/ De cribe work_ I�?yY� ir( CQ�c�
#7 Type of Job: New Add Alt Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME 4NFORMATIO /
Model Year Make [ //� Model
Length Width__ Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland 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 Scale:
Name of Fronting Street Date:
ICANT TO DRAW SITE PLAN BELO
If
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
ep PP I
Plumbing Fixtures Fee Mechanical Fixtures
Nq. 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 Boilers/Compressors
Dishwasher Hp
Disposal Air Handling Unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee
TOTAL PLUMBING $
Other
Gas ts.Hookups
Wood/Pellet tove
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 LAY 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 UL
OVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
J X OWNER X BY
DATE DAIS
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, NA 98584 427-9670/1-800-562-5628
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FOR OFFICIAL USE Y. Accepted by: ! �� Date
DEPARTMENTAL REVIEW
FOR OFFICE USE CMY
Approved Cond Hold
Approval
Planning:
Environmental Health:
Bui din+�j P1 Review: ��
Occupancy Group:
Fire Marshal: flammable and combustible liquids in this structure is not allowed
Other:
FEES
Ilspecial Conditions : II 11Site Inspection I II
II 11 II —A
II II IlBuilding Permit I oa
II 11 11violation Fee I II
II `� 11 11violation Investigation Fee I 11
II 2 ° 11 IL
II 11 IlPlan Check II
II II I I
II 11 II Plumbing Fee I II
it 11 1 I
11 11 11Mechanical Fee I it
II 11 I I
II 11 11Woodstove Fee I II
II II I
II 11 IlBuilding State Fee 1
I' 'I
11Building Valuation: II II TOTALI
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