HomeMy WebLinkAboutBLD29109 Floating Dock - BLD Application - 9/17/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
1
PERMIT NO-
OWNER [ A MAIL ADDRESS CITY 8 STATE ZIP PHONE
T.�. Gates III E. 6999 Hwy 106 Union, Wa. 98592 898-3333
DIRECTIONS
TO JOB SITE E. 6999 Hwy . 106
PARCEL 322335000902 LEGAL Trks 6 & 7 of unrecorded plat of trhs 5 & 6 of
NUMBER ✓ LEGAL
ZIP
NAME MAILADDRESS CITY&STATE P
CONTRACTOR ONHEUSE OF
LICEIISE lq.
BUILDING Floating moorage and recreational use.
CLASS OF NEW X X ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
I L
DESCRIBE
WORK Construct floating dock with attached recreational float set
sand screws and cross-chain anchor system as per attached plan.
AREA: 1640 + — NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE 0 CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 100 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED 0
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND 1 AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININGAPPROyAL FROM THE B ILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT,
X OWN E. 4 DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT Y APPROVED A
FFA No DEPARTMENT YESPPROVENo BUILDING VALUATION IMAP,
HEALTH i PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
ANPLIQhTIOfIAGCEPTEgQY, .PffqH 6Y ,. AP,P E RISSUANCE ,._ PERMIT VALIDATION
BY CASH CK MO TOTAL J 4.