HomeMy WebLinkAboutBLD92-01124 Cancelled Pole Bldg - BLD Application - 3/24/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
4$6 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS.
TO JOB SITE
PARCEL EGAL / l�-� ' t'
NUMBER J�-f�.6 t3 DESCR �OI�JG .(�ll� S A 4)../_I
CONTRALTO AME MAIL ADDRESS CI STAT "on N0.
�
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION EP MOV REMOVE
WORK r
DESCRIBE
WORK -
AREA: NUMBER OF: PLEASE IND TE: OTICE
SEPARATE PERMITS ARE REQUIR FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt RIES SHORELI CONDITIONING.
BASEMENT SgFt BkROOMS TRIMARY R A THIS PERMIT BECOMES NULL D VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 100 YS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS `� SXASONAL ES.Cl COMMENCED
FOR A PERI OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CAfiPORT JqFt FIRE AWE IS GARAGE
GARAGE Ft ATT D DETACHED O
OWNERS AFFIDAVIT CONT CTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE IREMENTS OF THE CONTRACTORS ERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AN
THE MASON COUNTY ORDINANCE WASHINGTON AND 1 AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT ISD THAT ALL WORK DONE WI WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHS SH BE MADE WITH IRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING :ENT. APPROVAL FROM THE BUIL T;&DA
XOWNER BATE -
T
FOR OFFICE USE ONLY
DEPARTMENT YtAPPROV NQ DEPARTMENT YEAPPROVED NO 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
Sf P n Q W MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO
Suite B•1021 Highway 99•Lynnwood,WA 1 037.3161
E ILDINGS Everett(206)258-4171 Puyallup(206)840 9552
Administrative Headquarters(206)743-1555
FAX(2061749401 Toll Free 1-800-824-9552
fi Contn - fi 1r TOWNCKOWLTi,
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lZIR E�Septtc and drainfleld Access to proposed building,
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Job ntml Job..$itl��Address
Legal Description ►/ �(
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Owner has verified and approved the location of accessories,orientation of the building to Ana vtrifies all' in
B of the contract are shown on this drawing and vice versa. Customer signature:
office(wMb) Production(can M production(Pink) euabmar(gddanod)