HomeMy WebLinkAboutBLD10418 Bulkhead and Shoreline Exemption - BLD Application - 4/27/1981 r-
} BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED _ 2 U
PERMIT NO. ld'4��8
OWNER NAM14p MAIL ADDRESS CITY&STATE ZIP PHONE
c .a
DIRECTIONS 10
TO JOB SITE 4.
LEGAL ( SEE ATTACHED SHEET(/
DESCR. S,� ��� ,d� %
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: PNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
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. PERMANEN SHORELINES
SEASONAL ❑ FLOODPLAI ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEP / X
H H DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
1 certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
//�� r ` _�j TION ACCEPTED BY PLANS CHECK BY APPROVED ISSUANCE
Ownet f � Z —Date. / L7 /� BY /N\//1
'(+�� i
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
,,
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EXEMPTION FROM SHORELINE .
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT /
TO: , Q ,? 11 hD S T 1
name and address of the applicant)
The proposal by S 4111 Pi to undertake _
(name of applicant
the following development r or c re�P �cf l l'�,��'i�__�n Q rDsl
(be specific)
upon the fo I ow i nq property s"r- k o f 1 r? 1/Y
( legal description; i .e., section to the
nearest quarter section)
within orce- II S �(�ye and/or its associated
(name of water area)
wetlands is exempt from the requirement of a substantial development
permit because the development a I sla-bi- r Zif -_ tf rowflrlf
I ? 3 - I q -nql) 1 L �
(identify exemptions as outlined in 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.
YThe guidelines of the Department of
Ecology where no master program has
been finally approved or adopted by
the department.
The master program.
f (date) (Sign ure of cal Govern-
ment Official )