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HomeMy WebLinkAboutMIS95-00844 Damaged Drywall Removal - MIS Permit / Conditions - 10/18/1995++irr+rri.cr+.rnY�rirrrYr - MIS MASON COUNTY • MISCELLANEOUS PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton,WA 98584.427-9670 PLEASE PRINT #1 Owner Ash-FDr-d. A 5,oucle s Phone# Fire District# Site Address /Ue• o;�6//FO y 1:r3 _City i � �✓' Mail Address GD /�D A dy —<= City S St W Zip . [G� Applicant Phone# 9/.,0 Applicant Address W City J li /t�J1�I St Zip Directions to Site: #2 Parcel No. - - 'W 70 Legal Descriptions #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 5/�'� Project Completion Date #5 Use of Buildiinge5/��i�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 SHALL BE MADE WITHOUT FIRST WITHOUT FIRST OBTAINING APP OVAL ROMTHEBUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPART MENT. X OW E X BY DATE 5S' r 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 1'OR©�FICIAL USE ONLY Accepted by gate DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Planning APP COND APP HOLD Building 1 a-a S Fire Marshal Other Special Conditions Fees Permit Fee $ Plan Check Other Other State Building Fee Lf, TOTAL DUE $ I aR C = a m - m & m _ m r0 � >a r +�► • -4 v Z --4 aza a* � o a air' a °' 'r, = --4 M& 9 y > -ai rw - h sa ' � Y r ice' 61 A 17D � Rl1 '� � V �' +p • y► �► 'Q � }oe ale as � M o -42 CJi4 '* off T" I V *0 � • ��zttw > >cc Go CA V A as Coco rlr �r v� -J rw 4 0 rn -4 m is is I mCD -� ° �. � -4m I, PO m us w m ° m ; so z h x ' ' o r I n = • r X I• cm O O r o nGo z D .. z r ao -t ?Z 0 0 OL 0 Vf m : a ° " 0 • 100. 0 _ < o o m m C • Q ® A �... C? r m m C � rc o ; m m2 z � _� � r r.. K z D V � s 0 Z os ammm : ac r mz aavz -► ate � 1 mma —00o M -4 mr o ° -4zaz � •z = • o -- z '- - .4r0 -4 �tN oI mn r ' wm = xmmo omw E? z oa Mfnccm4 m - a -4zz -1m > co 0 o "• mm - roc Z I '."-4 x m amcs � "" © AS 00 m to ; (A� a 00 y m _ 3` ° d o � 7 a ..� o > r% 3om XOD ca Cn r" f" -4• 1M C tai cn tv CP a m ' v -a ? m ° o -- - zo (D A m = mw O Q O m o2 = t" 30 ua a M o mar , -� ? 0, � �- -ioa m Z .- cy 3C z © -t � G O m rn 0 c oZ °sa - Q = z > ca0 oc c0�` �ma 4i e�+ �, �ycz I�I — ��� •CAM ca YJ - G { I- © MM- �- - 40 m .. < o a 0) m • a m qua m r -� 30 3a i I � n I f" 0 D V! f 3C( C m0 z -f z I CIO z0 _ m zw „ I � o cM o c� O Q Co 0 D A X0cj) � O ?z Z fa n O � = C ° N Z 0 � C � n z10 000 Q O z -4 � o