HomeMy WebLinkAboutBLD0448 Roof - BLD Application - 10/7/1986 BUILDING PERMIT APPLICATION,.
MASON COUNTY
�a q 44 1 - 061-70 DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED D 8'G
PERMIT NO.
NAME MAI AD SS CITY&STATE ZIP PHONE
OWNER 4 e 1Pz
DIRECTIONS
TO JOB SITE
LEGAL
NAML MAILAD RESS &STATE LICENSE NO. ZIP PHONE
CONTRACTOR
BUILDINUSE G
BUING
CLASS
WORK Or NEW i ADWT40N- "" ;i4l ERATIION REPAIR MOVE REMOVE
DESCRIBE
WORK d
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES _ BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNER AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTI THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIST TION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI ING APPRO ROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
e
XOWNER _DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT �� 5
D.O.T. BUILDING PLAN CHECK /V
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE 5' o
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS HE BY APPROVED FOR ISS CE PERMIT VALIDATION
BY CASH CK MO TOTAL /� & /