HomeMy WebLinkAboutFW94-0001 Fireworks Booth - MIS Permit / Conditions - 9/18/1994 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
M = S C E L L A N S O U S P E F2 M = T FOR INSPECTIONS CALL 427-9670
FW94-0001 PARCEL : 123294190110 PLAT : DIV: BLK : LOT :
JOB ADDRESS : NE 120 HWY 300 BELFAIR
APPLICANT : JIM STRODE 922-0800
OWNER : JIM STRODE 922-0800
L E G A L : TN 11 OF NE SE TN A OF SP 11321 FS 15215 R[ 164A
PROJECT DESCRIPTION :
FIREWORKS BOOTH
PROJECT LOCATION :
INTERSECTION OF HWY 3 AND HWY 300 IN BELFAIR
PROJECT NOTES :
TYPE AMOUNT BY DATE RECEIPT
PRMT $ 10 . 00 KS 03/22 /94 0037
i
TOTAL : 10 . 00 OW ER bRAGENT DATE
MIS PRMT, rev: 04/01/92
FW
MASON COUNTY
` MISCELLANEOUS PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
#1 Owner �1 tM s77�o� Icy t ,US Phone # Fire District# 2--
Site Address City {jtZF9lk
Mail Address
City St Zip
Applicant !w Aft /U C4RP Phone # 2e6 —%22 — 0800
Applicant Add-r�e-sus, A c • 6
City t rr( C9N�t/�- St Zip ���0�
Directions to Site: 3 L" l `
#2 Parcel No. I a3 a 9 ( 9 n I 10
Legal Description
#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 71 61g4
#5 Use of Buildiingl 1lza41 �J�l)Jy 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 FIRST OBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
ING DEPARTMENT. MENT.
X OWNER X BY
DATE DATE
Show following on the site plan
Lot Dimensions Flood Zones 1
Existing Structures Fences
Structure Setbacks Wells
Water Lines Shorelines
Drainage Plan Easements
Septic Systems . Name of Fronting Street Indicate directional by
Proposed Improvements Name of Flanking Street N, S, E, W etc.
PLOT PLAN AREA
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Planning APP COND APP HOLD
Building
Fire Marshal -31
((,,
Other
Special Conditions Fees
Permit Fee $
Plan Check
Other
Other
State Building Fee
TOTAL DUE $