HomeMy WebLinkAboutBLD21703 ReRoof/Storage/Work Area - BLD Application - 3/23/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUE
PERMIT NO
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER E /J Ge �� �Z� / /� � r ��- 33
DIRECTIONS d
TO JOB SITE
PARCEL LEGALT�--V7`s d'�S� L—G S- � i' INUMBERDESCR �JTS -H(,U I() GLK 10 ��-LyYj t • 17
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR LL, AJ t/H V.AJ i''Y YZ
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE — —
WORK I&CO = C1/=Y' G 7-110 - (,)m L
r r ��i� C:JQ ILL- a'� ! c= a r=
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
TOTAL SO.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNER AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIF +THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTR ION 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
O5TAI G APPROVAL FROM THE BUILDING D ENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X NER DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT YES No
BUILDING VALUATION
YES NO
HEALTH t PUBLIC WORKS FEE
PLANNING hi If if FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK j� 5
SPECIAL CONDITIONS BUILDINGGROUP m —2— PRE-INSPECTION
, SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEES
STATE SURCHARGE
APPLICATIONS TED BY PLANS,CC CK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
cc� r/ J P 91 TOTAL
,
ti��,�,,,� BY �/6 G CASH CK MO