The URL can be used to link to this page

Home My WebLink AboutMIS99-00277 Cancelled Abandonment of Oil Tank - MIS Application - 7/11/2004 PERMIT NO' MIS MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner z a to P 0-i %;. 1. 40/�40 1A Contractor Name Mailing Address k Ion go 4-/ Mailing Address City Lkd1gn State Zip Code ?,RT92, City State Zip Code Phone(�o )Ag1f-17(vZ Other Ph.L___) I Ph.( Other Ph.( Lien/Title Holder — S T0:4 C Contractor Reg. # Address Expiration PARCEL INFORMATION-12 digit Tax Parcel No. ��2 A& /.S( / p0 17 Fire District Legal Description Site Address(include street name and city Directions to Site.- Will timber be cut and sold in parcel preparation? (Yes/No)_ Is your property within 200' of the following: Body of Water(Name) i4neJ 0-4,r a L Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Describe proposed construction A 6 r h el, , 1� n�- 6�dg l �; Tn.h it SHORELINE PROJECTS New t Replacement Repair Expansion Bulkhead Material (concrete, rock, wood, etc.) Length Height A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF PERMIT. 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 AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above 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 CONTRACTOR'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 in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X � ' /'� '� ."A Date f" 9 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Dat Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Grp Type of Const. 2 Planning Department Environmental Health Department Public Works Department Fire Marshal 1 Valuation $ FEES Building Permit Fee Z a� Site Inspection Plan Review Fe Other UFC Plan Review Fee Other Violation Fee Pre-Paid at Submittal ( ) {HP iiY$:• TOTAL FEE S .:•:+:v:;:;::?��i::}:•,::iiiCi:fiiii::S::i:5':YY,.j::r::ji::}:::!:::ii$i:>iif:: :5;i. ^:;' MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98584 (360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 NOTICE OF EXPIRATION February 24, 2000 Laura Dalton 10090 E State Route 106 Union WA 98592 Re: Mis99-0277 (Abandement of Oil Tanks) To Whom it May Concern, The above reference building permit will be stamped null and void if not picked up by March 16, 2000. We allow six months after approval to issue. You have exceeded this time. The balance due is $19.00. Please feel free to call the office if you have any questions regarding this issue. r Thank You, Trish Wagner Mason County Permit Assistance Center PO Box 186 Shelton Wa 98584 (360)427-9670 Ext 352 DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: � 6% Qd Or r Building Plan Review Occupancy Group:P;L-Z Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit L{7, 5-0 Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee 4 Other Other Building Valuation: TOTAL FEE '7%. 1 _ 1 j Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) i No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other Bath Tubs No. Uaija Fees Showers _ Furn BTU i _Hot Water Htr _ Heatpumps Laundry Washer _ Vent Systems Sinks Spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins HP _Dishwasher No. Air Handling Units Disposal _ cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 _ Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE DATE i- �FOR OFFICIAL USE ONLY:Accepted by: Date: i