HomeMy WebLinkAboutBLD97-00084 Final Replace Fuel Dispenser and Product Piping - BLD Permit / Conditions - 3/18/1997 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 .3 cl by date by
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MIS
MASON COUNTY O�
MISCELLANEOUS PERMIT APPLICATION b
426 W. Cedar/P.O. Box 186, Shelton,WA 98584. 427-9670
PLEASE PRINT tf�1LL's Sho aln.
#1 Owner Lz e..Phone# (3(-6) zzs_30�`f Fire District#�_
Ulaiddress N F- ?`�1 up v City /3
lAddress F_ Z-14 t oo /Pa v4r, p U
City �cJ'�'a J r St W4- Zip 'F is s'z k-
Applicant ".-Ol'A Phone# (3 `-0 73 mJy 9
Applicant Address 1y c-5
City Cam. .. St w/¢- Zip gfrs 3/
Directions to Site: TW /Vor/-l` J�,J.'-• 3 ,4 B�(.L'..�,; S�r<< �S o•. �,,, �s
5 I�� O!— t`�J c�twa.y 3 n-�...- C,�e-....v�-c.-d� •�w� , S ►,�-� �1 e}.��,�.`
II
arcel
No_�-� M, ASM-m-
Des
cription
T12 Lo o n W 5 ct),, %K, e o F_ IS, !78
#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 2-_141_97 Project Completion Date
#5 Use
of Buildiiiing eow/M trc.J t,/ Describe proposed construction c !••r.c�
Y- � 1J s c.c.s z 4'h.W/ w+4�_ A_,cw T4 w
'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 SHALL BE MADE WITHOUT FIRST
WITHOUT FIRSTOBTAINING APPROVAL FROMTHE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
ING DEPARTMENT. MENT.
X OWNER X
DATE DATE �""['
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Wells
Water Lines Shorelines
Drainage Plan Easements Indicate directional b
Septic Systems Name of Fronting Street y
Proposed Improvements Name of Flanking Street N, S, E, W etc.
PLOT PLAN AREA
tvazl
r �
• b
qD
F(7R OFFI�IAt,U5 5 3k�iµ
���,A�pted by, ,�„ ate
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
�6(q7
Building
�13
Fire Marshal
(J/7,�i1
Other
Special Conditions Fees
`7r= 27 'co Permit Fee $
k L 7S = s Plan Check
Other
Other
State Building Fee
TOTAL DUE $ 1143 '-