HomeMy WebLinkAboutBLD11662 Swimming Pool - BLD Permit / Conditions - 10/29/1984 BUILDING PERMIT APPLICATION
1 MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED <l//
PERMIT NO. 11614 a.'
OWNER r ME MAIL ADDRES CITY 8 STATE ZIP PHONE
DIRECTIONS
ON—
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Z
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR['0., 42 -W 9,1,1 aS 7a
USE OF
BUILDING
Class of work: ❑ NEW DDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ j� 1� PLAN CHECK FEE PERMIT S�
SPECIAL CONDITIONS:
BEDROOMS 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 SQ. 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. PERMANENT ❑ SHORELINES O
Firm O A/ ��-' V SEASONAL ❑ FLOODPLAIN ❑
E.D. NO. S.E.P.A. ❑
y Special Approvals IN OUT YES APPROVED NO
Lic. No. LQ a� � �� Z - Date ZONING
7�f
PLANNING DEPT. Z40 6erklog
HEALTH DEPT.
OWNERS AFFIDAVIT
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 BUILDING DEPT. 11,412 /
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
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. pn BY�� p
PVA CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
n
i"mil J
i
EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT
(name and address of the applicant)
The proposal by (a(. /, Z, �" .L-�� to undertake
(name of applicant
the fo 1 I ow i nq development
af e&( St ,.Y �be sgw cl fic)
`7 �-�K
upon the folowinq property lei 4 — 7-.,2!,,v L ��
( legal description; i .e.,- section to the
nearest quarter section)
w 1 th i n r� cr-i' S and/or Its associated
(name of ater area)
wetlands is exempt from the requirement of a substantial development
permit because the development .��Jvice��f`td �c.•'I�-t 5�``3; e
(identify exemptions as outlined in WAC 173-14-0 )
(Corps Public Notice Number if available)
The proposed development is consistent or inconsistent with:
CHECK ONE
CONSISTENT INCONSISTENT
Policies of the Shoreline Management
Act.
The guidelines of the Department of
Ecology where no master program has
been finally approved or adopted by
the department.
The master program.
(dat (Signs ur of Authori (d Local Govern-
ment Official )
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14
2� I
Thomas, Charles L. #11662
10/29/81
25-20-2
Bergundy Road, Hartstene Island, Teamster's Exit.
Swimming Pool Contractor:
Quality Pools, Inc.
$16,700.00 Shoreline Exemption
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