HomeMy WebLinkAboutBLD2002-01220 fence - BLD Permit / Conditions - 8/31/2007 PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION q1P
426 W.Cedar/P.O.Box 186,Shelton,WA 8584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5 69 Seattle 206 464-6968
APPLICANT INFORMATION y CONTRACT R INFORMATION
Owner Contractor Na n e
Mailing Address WAA D-P, Mailing Addre s
City N State Zip Code `+' S City State Zip Code
Phone(_) 2. Other Ph.( _-, ) - Ph.( ) Other Ph.0
Lien/Title Holder d f_ "AAk/ic Contractor Reg. #
Address r Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System -"4--v.1
PARCEL INFORMATION-12 digit Tax Parcel No. i / Fire District
Legal Descriptionr!7
Site Address(Please include street name, street nurnber and city)
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water (Name) C Saltwater '
Lake River/Creek Pond Wetland Seasonal Run ff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use B ilding
Describe Work
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st F or 2nd Floor
3rd Floor Loft Basement Deck Other �'' sq. ff.
Garage Attached Detached Carport Attache Detached
MOBILE HOME INFORMATION-Make Model Model Ye
Length Width Serial No. No. of Bedrooms No. of at
Type of Heat Purchase Price $ Replacement Unit 26s )
Installer Name Certification o. A
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHOR ZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS i T ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Th owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the a ove described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR' AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in c nformance therewith. No changes shall be made without
approval, first obtaining apr roval.
X ' " Date , J✓ X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by ` Datej�& Submittal Amount Due Receipt No.
0EPARTN ENTAL REVIEW APPROV)wD pENIE>] CD'NDITI+JN CODES
Building Department
Occ Group Type Constr. -TA(---:`:5 No ck) CS
Planning Department i f
I
Environmental Health Department j
Public Works Department j
Fire Marshal I
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