HomeMy WebLinkAboutBLD19904 Gas Pumps, Canopy and Sign - BLD Application - 3/2/1987 Tlkz GAS PUMPS, CANOPY & SIGN
Permit No. 19904 No. Floors Sq Ftg
Owner FOWLER, Vernon L. Tel 275-3375 Date 3-2-87
Aaaress NE 170 Riverhill Dr Belfair Zip
Contractor Mickelson
Aaaress Zip
legal Description -24-23-1 Tr 6 NW,SW Tr C of S/P 178
Direction to project site North of Belfair Shopping
Center
Plumbing Mecnanical Sewer Wow Stove
r•ireplace Deck Garage Carport
Basement J nrr
Shorelines: Plumbing:
Setback: Mechanic
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
Footing:r/_C 1,11te
Setback:
Foundation
Walls:
Framing: PgRMIT
Fireplace: NULL & )g)io RY EXP',RAT'*ON
Wood Stove: oATra
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUE
PERMIT NO. Z `Y
OWNER N MAILADDRES CITY BSTATE ZIP PHONE
DIRECTIONS r
TO JOB SITE tl'lTjrr/• d i'= we
LEGAL _
DESCR. 6 F A-)(AD �,,)I-D
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR �'Gl69 t t -'
USE OF
BUILDING
CLASS OF NEW I _IADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK �S'i��J<1 is%D IJCa c'+ c i9.t T.?y,�� /� C�°lJ f�,t r/.t /� GSCe► .at Tp r'' ".
,q�'i.�1.d1 ,{ls �/� -�'.�'.r'�1.�',� ✓t�.q/.'L'� �Uit�J �?�Y_� "` �.,rll%c� T/(�S~ILL- So /
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.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 SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
r
OWNER AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY 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
REQUIRE 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 CON ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
O`TAIN G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XO NE9Gf1i1 �!'! ?/DATE ��
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING 2 FIRE BUILDING PERMIT 3
D.O.T. BUILDING PLAN CHECK e
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
J 1, ,r FJ - e lio be SHORELINE
�` PLANNING
Jot) PLUMBING
MECHANICAL
STATE BUILDING FEE
r
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CH K BY APPROVED FOR IS UANCEFPERMITVALICDATION
e4rTOTAL
BY H K MO