HomeMy WebLinkAboutBLD0477 - BLD Application - 6/16/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUE
PERMIT N IL lot
OWNER E MAILADDRESS _ CITY&STATE ZIP /PHONE '
r2d �/ E �5a C e u�2 e t C M� to z o2)7
DIRECTIONS
TO JOB SITE ,
PARCEL LEGAL
NUMBER DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE LICENSE NO.
USE OF
BUILDING esrD��ce
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 /� 0� SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT /d SgFt BEDROOMS 3 PRIMARY RESJff' THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS G Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
r �l ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE_ IS CARPORT/GARAGE
GARAGE Y 2 SgFt ATTACHED O 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 APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNE ATE Z'i- Z- X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVED
NO DEPARTMENT YEAPPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANSCHECK SY A ROVED FOR ISSUANCE PERMIT VALIDATION
j� BY CASH CK MO TOTAL