HomeMy WebLinkAboutMIS95-00319 Demo - MIS Application - 5/10/1995 MIS 0-7 '5Z-
- IlIIASON COUNTY
DEMOLITION APPLICATION -+-
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670
PLEASE PRINT
#1 Owner APhone #
Site Address
2 Jg City
Mail Address �7'✓ cc
City �j�/'77/ � St Zip,✓D�l� y,
Applicant �� ��� �✓Ly Phone#2�7���
Applicant Address tv
City St Zip
#2 Parcel No. Lq4 2"?J3 23 _ 0 0C2 Z—U
Legal Description
#3 How will the debris be disposed of? ce
#4 Use of building to be demolished? /9�1
#5 Indicate by circling the applicable source if any water is on or adjacent to the property:
saltwater marsh lake river pond wetland seasonal runoff other
Directions to Site:
#6 Project Start Date G l/ Project Completion Date
'Upon completion of demolition, owner must call for final inspection.
'Plot plan on back side of this paper must be completed.
DEMOLITION PERMIT FEES: $25.00 VOLUNTARY DEMOLITION
$40.00 ABATEMENT ORDER
'Make checks/money orders payable to Mason County Treasurer and sumbit to Mason County Building Department for processing.
Show following on the site plan
Lot Dimensions C b b Flood Zones
Existing Structures 3 Q(1y,, Fences
Structure Setbacks Wells
Water Lines Shorelines
Drainage Plan Easements Indicate directional by
Septic Systems Name of Fronting Street N, S, E, W etc.
Proposed Improvements Name of Flanking Street
00)
J
od I
C/
A 'A
Applicant Signature Date:
..............
...... ..
. . ...........
FORiO FICIAL Pted by. ..................................
...............
X.e.,
...................
..........
rhountpa ".....X:
Recel6fN6,
... ........ ...
..... ... ..
. ...............
. .....................
....... .....
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
FProposal Proposal
rl Approved Denied
Planning:
Building:
Fire Marshal: