HomeMy WebLinkAboutMIS94-0221 Cancelled Tank Removal - MIS Permit / Conditions - 4/27/1994 MIS
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 �7`�`�
PLEASE PRINT
#1 Owner /YIA.So" c4,r4( A-b+ Phone# Fire District#_L.�S__
Site Address w. ?9%-1
Mail Address S A B
City St Zip
Applicant At Jz"&o Pf Io r!�-ri- Stdu�cls Phone# 7.6,2-N 67 t
Applicant Address 212 /hsdd te &C k
City h6A&,at-S 5,353 2 St Zip
Directions to Site: MR'� to E k �F 0,N /114� Ca ck
I
i #2 Parcel No. 6 2 oz Z - 3 `� - c3 0 c9 n
Legal Description Szu '11Q�4C 1
#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 'P Project Completion Date
#5 Use of Buildiing Describe proposed construction
�c1,4 L o
I
V i plan may be required.
ce.
CONTRACTORS AFFIDAVIT
+`� QUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED CON-
MEh ° lU� t N LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM
RCS - Q ►� RUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT-
ORE ",,', � b� 'ERMIT ING THE WORK FOR WHICH THE PERMIT IS ISSUED AND
IS I; . V CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE-
FOR'- 1vGE5 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 BY `
DATE DATE _y/I 4/9 V
i
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=0a OFFICIAL USE ONLY:Ac:cepfed by
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
Building
V"
Fire Marshal
(44
Other
Special Conditions
Fees S, 00
Permit Fee $ s-��9 v�
Plan Check
Other
Other
State Building Fee
O
TOTAL DUE $
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg.III 426 W.Cedar
P.O.Box 186 Shelton,Washington 98584
(360)427-9670
BUILDING PARKS&RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
/96
TO: Inam rM, GJ k1 &41WD
ac�
C.Ct1�la, LA)A q
RE: Permit Number #
To Whom It May Concern;
During a recent review of our files, it was determined that your permit
may meet.one of the following criteria: --
1 . Permit is expired and needs to be renewed or have a final inspection
2. Due to the type of your permit and scope of work it is possible that
the work has been completed and it needs to be inspected to close
the permit
or
3. The permit is ready to expire and needs to be inspected or an
extension needs to be requested.
Permits are valid for 180 days from the date of issue to the inspection
date and remain valid for 180 days between each required inspection.
If our records are inaccurate and you have had a final inspection, please
send a copy of the signed off permit to this office so that we can update our
cards. If you have not had a final inspection and your permit is expired or will
expire within 30 days, please contact this office for a final inspection, update
inspection or extension prior to 9 /c36 /96 to avoid renewal fees. E
All permits which are expired or due to expire within the next 30 days will
become null and void if contact is not made with our office.
If you should have any questions regarding permit validity or the purpose
of this notification, please contact the building department for clarification.
Sincerely,
Building Department
cc: Property File
z 2
0
0 D
X
S S: \ / O
0
OD
.0 c
:3
-A ZZ
%� *1 Z
CD
(P
PO
p,
cn
ol
0
D (D
00
10 QL 01C)
OD
03
fn -4
Y
Q
cn
O D
x o
00O O
o, C
N
O OL
? � O
Q p., C
ti N
(Q
O (�
D (D
00 Q
Cn
00
t
r