HomeMy WebLinkAboutBLD2000-00646 DEMO - BLD Permit / Conditions - 6/2/2000 co
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
i date by INSULATION date by
i BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by
PLUMBING date by OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
ate by date by date by
1
1�
l"
i
FORM MUST BE COMPLETED IN INK fc�
PLEASE PRESS HARD
PERMIT NO.:
MASON COUNTY
DEMOLITION PERMIT APPLICATION '
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 48 5269 Seattle 206 464-6968
APPLICA6T INFOR A I N CONTRACTOR INFORMATION
Owner apt Contractor ame
Maili Address 0 0 t 1/Y Mailing Address
City �`6 State Zip C,nrip. City State Zip Code
Phone ' ther Ph.(_� Ph.L� Other Ph.��
Lien/Title Holder Of,14/t - Contractor eg. #
Address f Expiration
PARCEL INFORMATION-1 digit Tax Parcel N /� / Fire District
Legal Description /
Site Address(include str t n me and city /At
Directions t site: - li N f� C d (I
lk
yr
Is your pro,*Jperty within 200' of the following: Body oMNater(Name) Saltwater
Lake River/Creek� &0� Pond Wetland &/) Seasonal Ru off Stream lopes or
Bluffs_4 /f your project is located adjacent to or within an area that is I sted above, it is advisable to contact the Dept.
of Community Development regarding future development prior to demoliti n; since removal of an existing structure could
affect future building locations.
How will the debris be disposed of? Gt/VVIa
L
Ile ter s _-14 -
What is the use of the building being demolished? 0A/ (7/Y
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS T ANYTIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Th owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the a 3ove described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACT R'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the
ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued
will be done' onformance therewith. N hanges shall be made without and all work hall be done in conformance therewith. No changes shall
first obtain g pproval. be made wiO out first obtaining approval.
a e � )( Date
Provide a plot plan indicating loc pn of improvements and structure to be demolished.
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77
FOR OIT161AL USE BEYOND T IS POINT
Accepted by Dat Submittal Amount lue '�)b Receipt No.,
DEPARTMENTAL REVI W APPROVED DENIED I CO DITION CODES
Building Department �+, �L >FJ �; f� `•
Occ Grp Type of Const. _L
Planning Department
Fire Marshal
FEES
Building Permit Fee Othe
Violation Fee Other
Site Inspection Pre-Paid at Submittal
( )
TOTAL FEES