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Home My WebLink AboutMIS93-0165 Clearing, Grading - GRD Permit / Conditions - 7/16/1993 MASON COUNTY PERMIT Mason County Bldg, 111 426 W. Cedar NULL ,& YOID BY EXPIRATION P.O. Box 186 Shelton, Washington 98584 DATE BY " .1. G U.- t 1- A 11 0H 1-11 MA40N COHN I Y PARIc. 01,114I,k MASON COUN !"Y HARK`; W I f I 1 ON 0J m4 - FROM Bf i FAIR TURN LE Fl ON 1-0 NORTH SHORE ROAD— 60 APPROX 4)Nt-. M I I t 1URN It (fill I ON 10 SAM01,11 t I ROAD 60 APPROX . ONE 1111 I 10 PARK ADJAC"FRU N I 10 SANDHI I 1 1- 1 I-MI-NARY ',"CH001 I y1p f. n10,00N] 14� HA I I 1 1, 1 f"R M 1 00 1%" 0/ iti' 'Ov4 oo I ce y COMPI 1ANCl- 10 Al FACHUD COM01 I IIIN'i IS RFQ4JIRFD TONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b oundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. III 426 W. Cedar \ P.O. Box 186 Shelton, Washington 98584 t CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Ooundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by LAND MODIFICATION PERMIT Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT �� i� #1 Owner C-0, rA Et<S Phone# 4Z-�Y Site Addressf5k DH I LL,- A City L 11Z S Zip Owner Address +'� city S Describe Workur L LL JP #2 Contractor Name_ La-`> ` oo f---- S S � Contractor Reg# Address Expiration date / / City --SC—Zip—Phone #3 Engineer's Name Phone# Address Ci ty St Zip_______ #4 Parcel No. Legal Description SSG �cD =7a W NA � �, #5 Number of cubic yards to be excavated: 01 Number of cubic yards to be filled: L4-00 Number of cubic yards to be graded: #6 Will this be a balanced cut and fill entirely within the site? Yes —_ No •• If No: Will fill be brought on site? Yes No Where does imported fill originate from? Does fill contain any potentially hazardous materials? Yes No -- #7 Will excavated materials be taken off site? Yes No If Yes: Where will excavated materials be taken? #8 Briefly describe existin terrain, vggetation, and improvements on subject site? A-T [A. r r T1��'1 A i +r �4►1 -n rJ S t Tt= �� l�ti'1 (�2a U 1/Vl��i S S 1?- A 1►.��- #9 Has a soils report been completed on the subject site? If yes, include copy with application. 910 Does the subject site contain any of the following features? River Lake Wetlands Saltwater Slope greater than 15:• �_ Soft compressible soils Seasonal Runoff None �17 Will the proposed land surface modification change the points where storm water or groundwater enters or exits the site? t12 Will the proposed land surface modification change the quality, quantity, or velocity of storm water/groundwater? " O a designated shoreline? #14 Whaf urothods, if any, will be utilized to minimize r slon and Possible sedimentation into nearby waters? *—I #15 Will this land modification result in the redirection of any surface water. runoff onto adjacent properties? _ ��O #16 WiZ1-s face ar subsurface runoff be collected or controlled by interceptors, curtain drains, or other water collection devices once this land modification has been completed? S #17 Will the land be replanted upon completion? S If yes, with what types of plants? #18 What are the lengths and heights of slopes L. Z currently existing on the site? _ = oo ' = I D #19 Will this modification result in slopes steeper than those currently on the site? _ D If so, how steep? Show following on the site plan Directions to job site Lot Dimensions Flood Zones Existing Structures Fences �-�p �(��,L2-, Tu P-t'-) Structure Setbacks Driveways Water Lines Shorelines DO (0 Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street �l LC-- r1�E1�1 1�„�.f/:, r-�T 0 1 � , r Name of Fronting Street -,h4L LL-t- TO Scale: ��- Date: O'ISH 3'II302id 7.HalydDOd0.l mvuc Oil .LNVD17dcly= AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, � � va�- .�LtcVl,i1V1V OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AM A CLIRRENTLT REGISTERED CONTRACTOR CONTRACTORS REGISTRATION LAN RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMEMT.IA A �u N S DEPARTMENT. X OWNER i/��' X BY DATE _.o 2 DATE Return permit to: Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 FOR OFFICIAL USE ONLY Accepted by. Date. DEPAR AL REVIEW FOR OFFICE USE ONLY Approved Cond Hold Approval Planning: Environmental Health: Building Plan Review: Fire Marshall : f Other: