HomeMy WebLinkAboutBLD4451 Replace Canopy and Shoreline Exemption - BLD Application - 3/14/1977 46
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED f /, 7
0
�
/.JL- F_ 4 ,,S Ili,v PERMIT NO.
OWNER NAME~ MA(L ADDRESS CITY&STATE C,ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESC
�, i
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
JSE OF
3UILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION EPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
(CATION ACCEPTED BYJ PLANS CHECK BY ikb0`IQOVED FOR ISSUANCE Type of Occupancy Division
Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
ROAD DEPT.
By
Lic. No. —Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
Owner L EL2�'l ✓" �` Date SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
C - �' WORK IS COMMENCED.
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Courthouse Annex 2 N. Fourth & W. Cedar
P.O. Box 186 Shelton, Washington 98584
(206) 426-5593
building environmental health - maintenance parks&recre ion planning sewer&water
A.
EXEMPTION FROM SHORELINE MANAGEMENT ACT
SUBSTANTIAL DEVELOPMENT PERMIT REQUIREMENT
TO: Washington State Department of Ecology
Army Corps of Engineers
Mason County Commissioners
Applicant
The proposal by
10(0 -
to undertake the following development:
oUL
upon the f o I lowing property:
within
and/or its associated wetlands is exempt from the requireme t of a
substantial development because the development is
<< (01.4
MAC 173-14-040(_Z) •
Corps Public Notice Reference
The proposed development is consistent or inconsistent with:
Consistent Inconsistent
-Policies of Shoreline
Management Act '
Mason County
Shoreline Master Program
Date oT Approval Date of piration
This exemption authorizing construction shall be valid for two (2)
years provided construction has begun within two (2) years of approval
date. This exemption may be extended to five (5) years upon request
prior17t expitj
A thorized Local Government 0f iclal