HomeMy WebLinkAboutMIS97-00047 Cancelled Bulkhead - MIS Application - 1/31/1997 �. . _ MIS. �� �b �
MASON COUNTY
MISCELLANEOUS .PERMIT APPLICATION `
426 W.Cedar/P.O. Box 186,Shelton,WA 98584.427-9670 '
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Indicate by circling the applicable source If any water is on or adjacent to the property site:
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lake river eek stream pond wetland seasonal runoff marsh other
Project Start Date Project Completion Date r
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Use of Buildiing �a e_ ur�C.�t�vi s Describe proposed construction
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-Depending upon Ume type of penal.a floor plan and plot plan may be required.
'This permit Is valid for 180 days from the date of issuanoe.
ERS AFFIDAVIT CONTRACTORS AFFIDAVIT
3TIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED CON-
S-OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM
1827, AND AM.AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT-
NANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH.THE PERMIT IS ISSUED AND
>UED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE-
AANCETHEREWITH.NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST
OUT FIRSTOBTAINING APPROVAL FROM THE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART-
1EPARTMENT. MENT.
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