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HomeMy WebLinkAboutBLD97-1122 Install Awning Over Cash Machine - BLD Application - 9/24/1997 MIS MASON COUNTY MISCELLANEOUS$PERMIT APPLICATION PLEASE PRINT 426 W. Cedar/P.O. Box — --- - G p ifs-Y-36:200 — -- #1 Owner 2r Phone # S-SSigIAs_ Fire District# Lc Site Address . . 6 City de-14,,1 ` Mail Address <' X4 City St Zip Applicant -t-N G • Phone # O— ySf S_z' ©� Applicant Address City 0 ZSt cdzd Zip Directions to Site: #2 Parcel No. - - 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 #5 Use of Buildiing Describe proposed construction © 4 '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 FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPARTMENT. MENT. X OWNER X BYf X-7 DATE DATE i Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences vv 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. rPLOT PLAN AREA 1 w o -TO � h / roo3 � f P � gwnJn 5 7777777 FOR:OFFICIAL tJSE QNLY Accep#e !byy date: XXX DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Planning APP COND APP HOLD Building (,U� I6-/O�11 Fire Marshal Other ,Special Conditions Fees ?OK to 3O= 72-i Permit Fee $ 3S °b Plan Check ,y.00 Other Other State Building Fee `p TOTAL DUE $ S) `3. °� 9 qa.v Lq LA tA iT OD ical.�-ce.,-cc v.�-:e, � r- ,� i•.. V 1^ � � �,, � i � t 1 i' h .SSit F+i J Fi:�iA I t N ^�' � � o , , /' ����" � � +t. � try •+A ,� tl r4 IK iCaP\V&Y L