HomeMy WebLinkAboutBLD84-23003 - BLD Permit / Conditions - 11/4/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL ERVICES
P.O. BOX 186 SHELTON, WASHIN TON 98584
�► ., 427-9670 DATE ISSUEDc//
PERMIT
NAME r J
OWNER MAIL ADDRESS ITY&STATE
ZIP �P�HONE
DIRECTIONS
TO JOB SITE cc/z)(
ja
(
in
PARCEL LEGAL
NUMBER _ DESCR.
CONTRACTOR NAME MAILADDRESS _ CITY&STATE
LICENSE NO. ZI �c f PHONE
USE OF C. SE. ✓��1� W -
BUILDING ��� ��
CLASS OF
WORK NEW ADDITION ALTERATION RE IR MOVE
REMOVE
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SQ.FT. GARAGE SEPARATE PERMI' S 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 WIT, IIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR' ,PERIODOF180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT
CONTRACTOR AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I NM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AN 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 T 11REWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT.
APPROVAL FROM T BUILDIN EP RTMENT.
X OWNER DATE t
X B DATE G
FOR OFFICE USE O LY
DEPARTMENT APPROVED APPROVED
DEPARTMENT YES No YES 0 BUILDING VALUATION
HEALTH PUBLIC WORKS
PLANNING FEE
FIRE BUILDING PERMIT
D.O.T. BUILDING
PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP
PRE-INSPECTION
SHORELINE
WOODSTOVE �
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY STATESURCHARGE
APPROVED FOR ISSUANCE [PERMIT'VALIDATION
BY CK ID TOTAL A5, /i�