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Home My WebLink AboutMIS94-00930 Storage Only - MIS Permit / Conditions - 5/3/1993 z 2 - i z - - was. - T S • � _ OD Z _ - ° z ^ , 0 z _ : (D 10 Q. Z c Q I A T 1 I _ I - s 1 - O V/ . x /1 O .� ,o _I CT 7 z = _ - c CD oo 07 O Q N Z - o n _ CD _ _ _ _ _ - _ Q 00= Cr fl OD MI MASON COUNTY MISCELLANEOUS PERMIT APPLICATION s-;lyt _4 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 PLEASE PRINT Ct #1 Owner r C . > ; I ZZ e Phone# IYS, 5 Z '�'7 Fire District#�_ Site Address ;KJ. €_ 2 tf3 Mail Address S 1" City St tJc, Zip `i K 5 Z- Applicant Phone# Applicant Address City —St iip Directions to Site: e-,,a w \lri C� �1 C�LICU � S �4Gr � �( LccU� #2 Parcel No. Legal Description -'t 4t ' - #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 /Lr #4 Project Start Date r t O� tom_ Project Completion Date #5 Use of Buildiing ( t 11 t hr'4 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- FORMANCETHEREWI H.NOCH NGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST WITHOUTFIRSTO I ING VAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPARTM N MENT. X OW ER X BY DATE DATE MIs 4 aiac MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 � � PLEASE PRINT r^� nn O #1 Owner 5 -A' C> a I.VOOc]L _ A (9-} Phone# 275- 4`{S 3 Fire District#_�e-? Site Address tit 'O :&R6„�_.aJ�-3s' city JE1�Qf Mail Address S,on O city ��1-1.�, St Zip Applicant S+4wLQ Phone # Applicant Address wt_C City St Zip Directions to Site: � IL,5ILA. l t' its —f-a #2 Parcel No. j 'L3 Legal Description #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 r #4 Project Start Date \ — \ — �T Project Completion Date #5 Use of Buildiing L t'y\ v(//ze,frt� x t Describe proposed construction r LJ INI r\1 n.� .n �lT_sC& Kc, Ce- �' If W S e -- '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 OFTHE 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 FIRSTO TAININGAPPROVALFROMTHEBUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPARTMEN MENT. X OWNER X BY 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 by Septic Systems . Name of Fronting Street N, S, E, W etc. Proposed Improvements Name of Flanking Street PLOT PLAN AREA FOR OFFICIAL USE ONLY:Accepted by: Date: #t DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY APP COND APP HOLD Planning Building Fire Marshal Other Special Conditions — Fees Permit Fee $ Plan Check Other Other — State Building Fee TOTAL DUE $ MIS MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 PLEASE PRINT #1 Owner .0eJJV La-,, fi�e 5 L9 Phone# /-_lC �- 7 79- -3`f a3 Fire District# oQ site Address nE ��d E�ihl Rd # 35 city_ Mail Address / 73'/6 L F/7 o /n y4 � City l � Zip 5' 3 �n Applicant 7 l Phone# 41 7 9- / 7;Z/_ Applicant ddress J,-;�Q S 1�/��D City // St L[JCl� Zip Directions to Site: #2 _ Parcel No. <2 Legal Description #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 Project Completion Date #5 Use of Buildiing 7 j 40 e'l 0 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 FIRSTOBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPARTMENT. nn MENT. X OWNER X BY DATE �� 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 FOR OFFICIAL USE ONLY:Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Planning S 01101r4oW Si C APP COND APP HOLD �jm s Building Fire Marshal Other Special Conditions—A, Fees ��' `' — Permit Fee $ lrr lL�zt_e� h Plan Check &her Other State Building Fee TOTAL DUE $ Show following on the site plan Lot Dimensions Flood Zones ( . Existing Structures Fences M Structure Setbacks Wells Water Lines Shorelines Drainage Plan Easements Septic Systems Name of Fronting Street Indicate Srectional by Proposed Improvements Name of Flanking Street N, S, E, W etc. PLOT PLAN AREA M U' i r FOR OFFICIAL USE ONLY:Accepted by: !` " Date: 1f 34 4 cj DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Planning APP COND APP HOLD Building Fire Marshal Other Special Conditions — Fees — Permit Fee $ Plan Check — Other, — Other — State Building Fee TOTAL DUE