HomeMy WebLinkAboutBLD11094 Final ReRoof - BLD Permit / Conditions - 4/1/1982 i BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED ,/ — 7- F/
PERMIT NO.
OWNER N E I-L-ADDRE S CITY.& ATE.i ZIP PHONE
DIRECTIONS
TO JOB SITE ��� J�
(C SEE ATTACHED SHEET) r
DES .`` c I J 7✓ i,S � �'t��'l �0'7
f �- �Y 4�.R il/cC��Od�+✓- ,! S�d �yDt,�/�•-d� � i
CON RACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE REMOVE
Describe work:
7 S
Valuation of work: $ PLAN CHECK FEE PERMIT FEE_i,
SPECIAL CONDITIONS:
BEDROOMS._ _ {DECKS __ —_ CARPORT [] NOTICE
BATHROOMS____ TOTAL SO. FT.__. _ GARAGE i',
ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
IJO. OF STORIES BASEMENT i� OR AIR CONDITIONING.
TOTAL SC FT._ FIREPLACE DETACHED L
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor In WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT i_- SHORELINES 1
SEASONAL h1 FLOODPLAIN C
Firm
E.D. NO. S.E.P.A. ":,
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in confor ance therewith. MOTOR VEHICLE PERMIT
�^ APPL CATION A EPT BY PLANS CHECK BY P ROVED FOR SUANCE
Own -- Date . Y
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. H
EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL '
DEVELOPMENT PERMIT REQUIREMENT
TO:
(name and address•of the applicant
The proposal by �1 to undertake '
(name of applicant
the folloAng develo merit
, o_-�
(b6 specif )
upon the folowinq property /l1L1/J o204 / •,
. ( egal description; i .e., -sectlon to the.
nearest quarter section) . - . . .
within - jand/or its associated '
name of water area) -
wetlands is exempt from the requirement of a substantial
development..-
ermit because the deveiopmenfi -cot 52�
' _v Y6_ r/7 )
(identify exemptions as outline n WAC 173-14-040)
(Corps Public Notice Number if available)
The proposed development Is consistent or inconsistent with:
CHECK ONE
CONSISTENT INCONSISTENT ,
Policies of the Shoreline Management
--- - Act.
" The -guidelines of -the Depar+men•t of
Ecology where no master program has
been finally approved or adopted by -
the department.
The master program. _
(date) (Si ature o uthorized-Local Govern-
ment Official )
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