HomeMy WebLinkAboutMIS96-0899 ReRoof - MIS Permit / Conditions - 12/18/1996 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
M I S C E L L A N E O U S PERM I T FOR INSPECTIONS CALL 427-9670
MIS96-0899 PARCEL :420122200110 PLAT : DIV : BLK : LOT :
JOB ADDRESS : E 1500 SHELTON SPRINGS RD . SHELTON
APPLICANT : JOHN FLYNN
OWNER : JOHN R FLYNN
LEGAL : TR 11 OF NI II
PROJECT DESCRIPTION :
RE—ROOF
PROJECT LOCATION :
GO NORTH HWY 101 TURN RIGHT ON SHELTON SPRING RD . GO APPROX . 1 /4 MILES WHITE HOUSE ON LEFT .
PROJECT NOTES :
TYPE AMOUNT BY DATE RECEIPT
STFE $ 4 .50 CPH 12/ 18/96 CASH
R E R F $ 32 .00 CPH 12/ 18/96 CASH 5
TOTAL : 36 .50 OWNER OR AGENT DATE
MIS—PRMT, rev; 04101/92
4
MISS
MASON COUNTY
MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
#1 Owner Phone# Fire District#
Site Address 3 C1 City
Mail Address r�
City St um Zip
Applicant
Phone# / / " '� --
Applicant Address
City CJ Stt�%1 Zip `✓ S'
Directions to Site: Qo /V
#2 Parcel No. f7 �- Ir�C�//�
Legal Description ,�/ G�/V& AZU) oG'
#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 Project Completion Date
#5 Use of Buildiing 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 REGISTERED CON-
MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT-
ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERMIT IS ISSUED AND
IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE-
FORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST
WITHOUT FIRSTOBTAINING APPROVAL FROMTHE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
ING DEPARTMENT. MENT.
X OWNER X BY p p
DATE DATE / al —I /f
Show following on the site plan `
a
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Wells
` Water Lines Shorelines
Drainage Plan Easements Indicate directional by
Septic Systems Name of Fronting Street N, S, E, W etc.
Proposed Improvements Name of Flanking Street
PLOT PLAN AREA
FOR OFFICIAL USE ONLY: Accepted by: Date
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
APP COND APP HOLD
Planning
Building
Fire Marshal
Other
Special Conditions Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee
TOTAL DUE $ �