HomeMy WebLinkAboutMIS94-00289 Cancelled Replace Pilings - MIS Permit / Conditions - 5/11/1994 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 ,.tax O'er
PLEASE PRINT
#1 Owner 1.) S Phone# —R(9� D
Site Address Zl� Fire District#
City �N rz �` n St Zip
Directions to Job Site -EkVt2 G'LJ 0,Sr)tJ Lrk�� fZll1 1�a S i
Owner Mailing Address - \
City -E;,( -g,(,;77,r) r--o,A t/1
Lien/Title Holder
Address —
City — St Zip
#2 Contractor Name SOLE- Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No19oA'-R - L0 00 1 O
Legal Description --�5C :::c ZZ lZ Z
#5 Building Square Footage: (existing/proposed)
1st FI / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other ILI U S sq. ft. /
#6 Use of building -E)oC-V- Describe work
#7 Type of Job: New Add Alt Repair_Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat
Purchase Price $
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($$3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
Hot Water Htr Heatpumps
Laundry Washer _ Vent Systems
I Sinks Spot Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins HP
_Dishwasher No., Air Handling Units
_Disposal _ cfm#
Urinals No. Fire Protection Systems
Other _ Auto. Fire Alarm Sys 50�00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00
TOTAL PLUMBING $ No. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDI DEPARTM DEPARTMENT.
X OWNER X BY
DATE 9 — t ( A 4 DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
Environmental Health: !hp�
Building Plan Review�t�i�stdfJk, A_
I v,�
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit -7 _ d —
Plan Check
G 7J
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: TOTAL FEE -- d
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'YRIGHT BY THOS. C. METSKER
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MASON LAKE PARK
MASON LAKE PARK
MASON COUNTY
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MASON LAKE --
MASON LAKE PARK — 2.36 Acres
Location : on the northeast end of Mason Lake approximately 5
miles north of highway 3 on Mason Lake Drive West .
Mason Lake Park is the only freshwater access type park the
county owns and maintains . It provides the public access to
the northeast end of Mason Lake .
The park includes a boat launch for boats up to 18 feet ,
a dock , play area, restrooms, barbeque pit and an adequate
parking area .
Due to shallow water it is sometimes hard to manuever boats
and swim at this site .
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