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HomeMy WebLinkAboutBLD30095 Storage - BLD Application - 3/17/1992 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584 �`j 7 C�a 427-9670 DATE ISSUED a PERMIT NO. OWNER -NAME MAILADDRESS CITY&STATE .$ssa ZIP PHONE�a� oci n e & So 1 Zl? q*lls L fie. le t 12 a DIRECTIONS TO JOB SITE PARCEL LEGAL NUMBER v DESCRffI241 L6 f 0 D 1 &4 l LCM a NAME MAIL ADDRESS CITY&STATE ZIP PHONE UCEM NO. CONTRACTOR e USE OF BUILDING SA o v-o -e- CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK AREA: NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE SgFt STORIES SHORELINE O CONDITIONING. BASEMENT Q SgFt BEDROOMS O PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS a Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR $g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. CARPORT <Z;> SgFt FIREPLAC , IS CARPORT/GARAGE GARAGE (Z;> SgFt ATTACHED U DETACHED OWNERS 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 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 APP AL FROM THEBUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. fX NE d�' / TE 1� XBY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO I��7 HEALTH NT PUBLIC WORKS FEE PLANNING FIRE MARSHAL BUILDING PERMIT do D.O.T. BUILDING PLAN CHECK (©'L SPECIAL CONDITIONS BUILDINGGROUP nt--I PRE-INSPECTION SHORELINE oa�� �� fe�df�6 WOODSTOVE iqq� �✓�� I �q PLUMBING MECHANICAL STATE BUILDING FEE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL { .� 311. q�- BY 'J�l j L�a. CASH CK MO