HomeMy WebLinkAboutBLD0495 - BLD Application - 3/3/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
1 d PERMIT NO._� S
DIRECTIONS
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CONTRACTOR r�NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING ge J o.k l" W a�� f e r bs'� a c o„t /. �� �v r 3�%i d rts,
CLASS OF j
WORK ✓ TN ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE WORK c L
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BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SQ.FT. FIREPLACE DETACHED COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNER AFFIDAVIT 00.17
CONTRACTORS AFFIDAVIT
1 CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR ?HE STATE cq OF
REGIST TION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUI MENTS 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 C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA ING APPROVAL FROM THE BUILDING DEPARTMENT.
APPROVAL FROM THE BUILDING DEPARTMENT.
NER DATE
X B DATE
FOR OFFICE USE
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES No YES NO BUILDING VALUATION e� 4
HEALTH PUBLIC WORKS
PLANNING FIRE FEE
BUILDING PERMIT 3S' �
D.O.T. BUILDING
PLAN CHECK R�
SPECIAL CONDITIONS BUILDING GROUP
nn PRE-INSPECTION
rn hem - r� SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
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CASH CK MO TOTAL