Loading...
HomeMy WebLinkAboutMIS97-0404 ReRoof - MIS Permit / Conditions MIS _ ' MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 PLEASE PRINT QQ ccz� Q #1 Owner d�0,8 D/ tl 5 Phone # gig 7�1,9 Z Fire District# Site Address V60 e City qAlzogl Mail Address �1 x city Zip g57Z Applicant Lsoi✓ GOiYST. Phone# g— O Applicant Address go P C4r /- S City Directions to Site: Z(D p Zo 6 {/ r #2 Parcel No. 3 2 Z 3 S _ 3 ( _ O O Z Z- Q 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 / _p 3 ^ Project Completion Date — #5 Use of Buildiin 5 F,�Z 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 I IEGISTERED CON- MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHI GTON AND I AM RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIRE MENTS REGULAT- ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERI 41T IS ISSUED AND y IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE= FORMANCETHEREWITH.NOCHANGESSHALLBEMADE WITH. NO CHANGES SHALL BE MAD= WITHOUT FIRST WITHOUTFIRSTOBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROVAL FROM THE EUILDING DEPART- ING DEPARTMENT. MENT. X OWNER X BYZ�tz — DATE DATE -O J le O 'm,-i < m 0 m a 'a 0 - I O 'O Co Co t C a --I -S -t 'a L C- 9 L m _ r - a -?� m m m O 1 On On mfC') ov m - 9to 1 9 -i n -i a z > Om > mz a > z xr av r -.i mm m - a O o m in _ _ _ O b > -I -{ 0 CA q7 N r m -4 w .0 O .omi O -ai vp .- 00 > c `a W m mm I CA m CA z m D m Qt9 -+ 0) z 0 -q OO; mm � a > mr z O < Or z - - S [a m 77 - (A 0) N m m 2 cNi. i O N 0 1W V v 9 e a CT 7 v — 'W C.) -> C i m m m .{ r A a1 m' © m - 3 7C a In V r z oo O D m O cn z a O o� m x � O � J O N 7 Z O DI. CD o0 > z { Q O 'i m � T `'.'' ` 0 i U o � 0 9 C O (D m to �'� ZG OODDQ CQnD Cnpo ,r r �A v y r 7A j z i I 0 ' A is on am x xaD 0 .. nr a - z o - mr m r r w 0 a z 0 r 0 0 0 0 0 r m r n c o - 0 o n r - 0 - -i 0 n 0 m m 0 xz zm g m_ z - w � 0 -i kz D 1 07 co m — a -n a cD Oc 2 0 Ti � c O V -+ o co o c m o > "n �i 'am sa -i < O 0 m - - ' coo on o CO Z m z -4 < •n o z J mw m3 0 -i Om me m z � c _ 00 � aa' To m ; 0 --1 z 0 3 4 m ax o -n m - h m > 2 m 00 m-q —i m i a C mo QD oI 0 Z � a om -zia a �� C'm < — 0 m .. O x mm zm x -icy ax cm o - m y p m rn Om o a m 20 co 1 J x m OQ S O < T r 8. . D 'i 2 r r W 0 m o O c m > m > OD C m to - - Z z fn m N 0 O �` . D v c a (p co a > r m x w o D 0 Q O - m z m > 7 D ¢? D 0 z < m o0 x < o Q A O D m > � N C r - 01 rn O rn cQ < m - 0 n rz o m - a - fn z m c 10 Q. C r co Q o r o o po D m m A m m D m - a 0 z i m w w 0 c m O r nD D -; r - r z - z � o c 3 a ca wW - -0aD = m • i m m D m a D m 0 wm -.4m C a -im0 m MI - i — 00 m -p --� m O -iz COS 2 z — — -I r O -1 i cn -na m < O z D m D 0 m v . z i * -n O T m v zmc :azro mm - 0a — c M. 9 M > z i m we - 1 0mrd -4 mz 'n O D 2 9 — O zmlmwm m gym = o avDrn Oz D -i i ai m no m c33 1z -im Dm 0 S m O c r 0) a r mD Omv z 71 .. D •imx r/1 — y7 — m m W z r m a m M rn 0 O (n 0 1J ozvvvo 13- m Q 1rm � m 71 � Dmma- x cn 0mm0 < � pp0Or '^ '-1mv l0m � v' - m n O onamv = 0 - _ _ ODm00 --izz Ol7 z v � i cm cD W ` )a O Q_0 O m a x O z O (nIDm . .— !Gra 0D m A r < aia Q A z za)v � 00, z - r - m 7 < •nmDOm 000rnz0 CQ mmx0 -i 1 � zD — 0 (� iayzoaz 0 Oc < 0 -1 `OQ- c O m 00 Q mrrnz CT� my — -ia; w Qo 0 - -i < m- A czm mo aD Cl) — err -i0zC > — Oro — — zvvrzin G) mmOr - 0 — < m � - m iz — — O < rA ro r z w rn - m . wn m D