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HomeMy WebLinkAboutBLD2005-01206 DEMO Final - BLD Permit / Conditions - 8/18/2005 ■inrnr�r FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD PERMIT NO.: MASON COUNTY DEMOLITION PERMIT APPLICATION `� 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 276-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLIGAN.'G.INFORMA CONTRACTOR INFORMATION Owner ' Contractor Name Mailing. ddres Mailing Address City State 6_)T Zip ode City State Zip Code Phone they Ph. Ph.( Other Ph.c Lienfritle Holder Contractor Reg. # Address Expiration / / 711 PARCEL INFORMATION-12 digit Tax Parcel No. / / Fire District Legal Description ` &.Ar C. Site Address(inclu'de sWeetiname and city Directions to site: Is your property within 200' of the following: Body of Water(Name) Saltwater__ Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs If your project is located adjacent to or within an area that is listed above, it is advisable to contact the Dept. of Community Development regarding future development prior to demolition;since removal of an existing structure could affect future building locations. How will the debris be disposed of? J rn ern a 7 What is the use of the building being demolished? S NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done ift nformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining ap roval. be made without first obtaining approval. �j ``9 X Date /- - X Date nm O -o Provide a plot plan indicating location of improvements a s r11�>kir©o be demolished. c m 0 ,o i W C -� t Q -G 0 hC-7 r O C7 rr] CU „> ca r"�7 x m � v o r az C/) m i t i i 1 FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Grp Type of Const. Planning Department PALA Fire Marshal FEES Building Permit Fee Other Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) TOTALFEES / / 0) k / § C- CD • ■ ¥ - m / § w 2 k % q M E . J fR a o \ �k / • o E D / \ 00k i � CDo - q § m k o « ƒ k �oM � � c � OE \ § \2 z � k $ U) { \ 7 K o m ¢ § / IA o B \ � q ƒ 00 0 32 � / / >CA r - 0/ Ckn / m/ �/ � Z f a o z @ E .M % # 2 2 = 7 2 % g / X ' ' M \ k \ 0 7 / o / / mo / ) CD $ / \ k m q m � O \ cn / \ 7 0 E E m m 2 0 7 -n -n m 3 / o z 2 7 . . . & � / � c k 0 �2 r CD © Z 0 CD _ a) 0 $ ■ / / 0im $k a o k c g @ - 0 cn d am « r \ 2 T. § / k k 0 R 2 ] G \ c . . 0 � § \ Q m CO) � Cao m as -n - . CO) � ( � --I ic � 2 { » . z ] -n Z . m m _ Q k CO E o 3 E @ CDCD CD s FT E $ # - - / \ ƒ k 7 XAo / / @ / 7 § q } m 2 2 § o - M f CL C § \ � 0 2 > E _ it � � � E Za Z Z & m § k k ¢ U) 2 40 » ] a 2 m 0o / § \ i � 0 / . � cn0a § (D o § Gk o $^ CA) ,»,e k co q cn \ \ /,/ � C) CDk k r . oa9 / m w _ . o \ � � § / CD k q < CY CD ® o C l< @.\ / . > k � / CD CD z C \ CD \ a 7 § 2 �0 100 . J § BE CL A cn / E. ! cCD 0Sf :E o k / f ( CD 2 = n ,o(D E � D ; R - m — _ o a § gym' -0a / \ E CD ' _ qa ¥ D CD 888 \ . CDCD2 CDO Ek E > K � R � FL co $ En ƒ� § Tr �� \ k 5g8 . \ \ � \ � Eo / _ / / k ( q � . CL0 � / ico REk \ Cr CD & & a % J & / § D § E � f ° \ �\ \ (nEa & CD . cn CA) R 0 & 00 9 / \ CD � � o . o � 00 o CONCRETE MECHANICAL MANUFACTURED HOME o ' o cl, Fo Olnp I Setbacks Date By Ribbons N Date By Gas Piping Date By rn Fot dMion Walls Date By "p Date By INSULATION Date By so t Stab Insulglon Flours FINALINSPECTION Data By Date By Die By FRAMING WWis FIRE DEPARTMENT Date By Clare By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING DaW By D.W.Y SOMEMIMEM Date By Water Line FINAL I NSPECTION 77 Date By Dots �/�- y / � ', Data By m s Type of Insp. Pass/Fail Request Date inspect. Date Done By Comments T o W 0 0 8 0 � o ca a 0 N z 0 as _ O 0