HomeMy WebLinkAboutBLD10390 Final Mobile Home and Shoreline Exemption - BLD Permit / Conditions - 10/15/1981 GLOVER, John F. & Susan #10390
04-13-81
Lake Collins
Lot 18, Collins Lake No. 2, Volume 6 of plats Pages
70, 71, and 72.
Contractor
Dons Mobile Home
Mobile Home
Shoreline Exemption
$9,000.00
f ,6
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE 4 ZIP PHONE
S,0, Hil fN
DIRECTIONS
TO JOB SITE
LEGAL f ``// �I (❑ SEE ATTACHED SHEET)
DESCR. < C' I� Coo / S E /l/D. v�,0 G P'< TS A es 76gof TZ
E f �AAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR D` ,� �}O )
USE OF /v /J�
''d �� ��C
BUILDING
Class of work: 110NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
A0b1°/ 1-10/27P 6
Aensv,p1p, C�2O ' X '�/
Valuation of work: $ VV v PLAN CHECK FE PERMIT VE
SPECIAL CONDITIONS: I A' y� d
6 � I
BEDROOMS DECKS RPORT ❑ NOTICE
BATHROOMS_L_ TOTAL SQ. FT. GARAGE Ll
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT./la FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- �
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
1 certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES I I
SEASONAL ❑ FLOODPLAIN Ll
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT. l !
which this permit is issued and that all work done will ROAD ACCESS
be in co ce therewith. MOTOR VEHICLE PERMIT
TION A EPTED BY PLANS CHECK BY APPR D F R I SUANCE
Owner Date BY
P N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT
TO: D S 1�
P1 A04
name and address of the applicant)
The proposal by S U to undertake
(name of applicant
the following development ,
e-,
( e specific)
upon the folowing property
( legal description; .e., section to the
nearest quarters ti )
within (,p_ ��1-n S f L a and/or its associated
(name of water ar a yea)
wetlands is exempt from the requirement of a substantial development
permit because the development 5' `
r�
y
WAr oz- Ig j
(identify exemptions as outlined in WAC 1 3- 4-040)
(Corps Public Notice Number if available)
The proposed development is consistent or inconsistent with:
CHECK ONE
CONSISTENT INCONSISTENT
Policies of the Shoreline Management
Act.
X The guidelines of the Department of
/\ Ecology where no master program has
been finally approved or adopted by
the department.
The master program.
13
(date) (SigrLa4`ure of Aut orized oca Govern-
ment Official )