HomeMy WebLinkAboutBLD23083 Sign - BLD Application - 12/1/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.C]/�� A3
NAME MAILAjRESS p Cw�STA�TE ZIP PHONE
OWNER t'� r C-21 �01°/v�� &W
DIRECTIONS �^
TO JOB SITE Q (v$�' --/D r -
PARCEL LEGAL
NUMBER�p2 DESCR.
�-NA E AIL ADDRESS CITY TATE LICENSE NO. f ZIP dPHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW �- ADDITION ALTERATION REPAIR MOVE REMOVE
WORK All
DESCRWORK IBEX N
BEDR S DECKS CARPORT '
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BAS NTr'- ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAC
�WXERSAFFIDAVIT CONTRACTORS AFFIDAVIT
CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. f( APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNE E �v XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH Aj( PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT se"NEw-
D.O.T. BUILDING PLAN CHECK --------- -
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY �=ECKBY APPROVED FOR ISSUANCE PERMIT VALIDATION
___r BY /2 8 CASH CK MO TOTAL