HomeMy WebLinkAboutBLD11711 Pool Enclosure - BLD Permit / Conditions - 11/10/1981 CA TJ K O 0 fD M r O r 17 to 0 I I
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 DATE ISSUED
PERMIT NO. /17//
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL EE ATTACHED SHEET)
DESCR. _ —4617
7
CONTRACTOR
NAME MAIL ADD ESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
Describe work:
zM� 0
4 Valuation of ork: $�� PL HECK FEE PERMIT
G
SPECIAL C ITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
NO. OF STORIES BASEMENT ElATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ElDETACHED ❑
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 ❑ SHORELINES ❑
Firm 6W r'( 6 'VrC I I A ! . SEASONAL ❑ ElFLOODPLAIN
e E.D. NO. S.E.P.A. ❑
By ° AAj
Special Approvals IN OUT YES APPROVED NO
Lic. Noly—O&—U K 3 Date Z ING
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 gU1LDl G DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will
be in conformance therewith. MOTOR VEHICLE PERMIT
AP LIGATION ACCEPTED RY PLANS CHECK BY APP OVED FOR ISSUANCE
Owner Date. f
61
PIVN CHECK VALIDATION CK.. M.O. CASH P MIT VALIDATION K. M.O. CASH
EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT
TO: 11,-�7z_
Q.C.
name and address of the applicant)
The proposal by YQnj.vi to undertake
(name -of applicant
the following development (f ,' , p d
(be specific)
upon the foIowing property /V I' Al S(t/4 (0-r 10
( legal description, i .e., section to the
Scc . 4 an A/ J,I
nearest quarter section)
within RCLOC , pdg:cQe, and/or its associated
(name of er area)
wetlands is exempt rom the requirement of a substantial development
permit because the development
1 1
(identify exemptions as outlined in VIAC 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.
X The guidelines of the Department of
Ecology where no master program has
been finally approved or adopted by
the department.
The master pro(
It v -e ;
date) ure 'of Au-Woriied L cal Govern-
ment Official )
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