HomeMy WebLinkAboutBLD92 Roof Enclosed Patio - BLD Application - 3/9/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
W I i omt FG- 'Df M62- Sc / l 2YE--b-212
DIRECTIONS
TO JOB SITE 'o
PARCEL LEGAL
NUMBER v 2- 1'0 DESCR.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR G iti rl/e l/'
USE OF
BUILDING
CLASS OF NEW ADDITI ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK Q 0A1 �/1- e`'
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES�_ SHORELINE❑ CONDITIONING.
BASEMENT 0 SgFt BEDROOMS 2 PRIMARY RES.Q THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS 2 SgFt BATHROOMS SEASONAL RES.Wr COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT d SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED Q 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.
J
X OWNEL�l DATE ILZq2— X BY _ DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENo 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
FICA ION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
f j TOTAL
1 BY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME AILADDRESS ITY&STATE ZIP PHONE
OWNER W, �l'Q M lv /V L .
DIRECTIONS 24'8"—. i 96
TO JOB SITE 5y�?r
PARCEL Pj V � LEGAL
NUMBER ' 0 DESCR. A?,
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building & septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage.
O Attach copy of septic system "as built" or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
ly
4
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval.
SIGNATURE OF OWNER(S) AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT A N