HomeMy WebLinkAboutBLD2006-00717 Cancelled Demo - BLD Application - 12/28/2006 PERMIT NO.: UP
MASON COUNTY -
DEMOLITION 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 " Contractor Name
Mailing Address k Mailing Address
CityT LWState NA� Zip Code City State Zip Code
Phone(3�_�Other Ph.( Ph.( ) Other Ph.( )
Lien/Title Holder �q4tA ' a � `425� t Contractor Reg. #
Address z f � 1, , A Expiration
PARCEL INFORMATION-12 digit Tax Parcel No. Q9 / / )UO/cAU Fire District
Legal Description & ShUE'L I ¢ g t 26)
Site Address(include street name and city > t
Directions to site:_
L
Is your Oroperty within 200' of the following: Body of Water(Name) Saltwater U
Lake AJ 1 Rive r/Creek-,Uf) Pond ,>j i, Wetland All) Seasonal RunbffV0 Stream D Slopes or
Bluffs��/f your project is located adjacent to or within an area that is listed Above, it is advisable to contact the Dept.
of Community Development regarding future development prior to demolition; since removal of an existing structure could
affect future building locations.
How will the debris be disposed of?
What is the use of the building being demolished? OL
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-1 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 i At-fit Date X Date
Provide a plot plan indicating location of improvements and structure to be demolished.
Bed,,,,
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FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department
Occ Grp Type of Const.
Planning Department S
Fire Marshal
FEES
Building Permit Fee ) Other
Violation Fee 1 Other
Site Inspection Pre-Paid at Submittal ( )
FEES
»: TOTAL E