HomeMy WebLinkAboutBLD23043 Shop - BLD Application - 11/17/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
S Onu
PERMIT NOC Yl�
OWNER NAME �,. MAI DDRES�j CITY&STATE ZIP PHONE
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DIRECTIONS n ,
TO JOB SITE
PARCEL LEGAL
NUMBER /2��9-/3-D/coo DESCR. 4& F 1r /-- I
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NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ v
DESCRIBE D�WORK
WE HAVE NOT BEEN ABLE TO'LOCATE` RECORDS OF HE INSTALLATION OF THE SEPTIC SYSTEM - THIS WI
NOT-A t F NANCING OR SALE OF THE PROPERTY. ENVR. HEALTHAF
BEDROOMS DECKS CARPORT NOTICE
'SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. _ GARAGE 1/ �r7 CONDITIONING.
NO.OF STORIES BASEMENT— ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASON
OWN S AFFIDAVIT CONTRACTORS AFFIDAVIT
I CER FY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI RATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ EMENTS 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT NING APPROVAL FROM
THE
(BUILDING DEPARTMENT.. Q APPROVAL FROM THE BUILDING DEPARTMENT.
NER DATE l7`f- �n X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPRovENo DEPARTMENT YESPPROVENQ BUILDING VALUATION
HEALTH ! or PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT S�d
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP _ PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
1-66
STATESURCHARGE '
APPLICATION ACCEPTED BY I PLANnHriCK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
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