HomeMy WebLinkAboutVoid Wood Storage - BLD Application - 8/14/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY SSTATE ZIP PHONE
6.
DIRECTIONS
TO JOB SITE
PARCELEGA
L
NUMBER �ILI/� DESCL. �� <Fj ) I S
NAME MAIL ADORESS CITY 8 STATE LICENSE NO. ZIP PHONE
CONTRACTOR iC LOCI( PL SFtcmoj ldc -( qq i}3 2 �-7 23
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK wcob
BEDROOMS DECKS YOR N I CARPORT TOTAL ICE
TOTAL SQ.FT.
DECK GARAGEEPA TE PERMITS E REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. TOTAL SO.FT. CONDI NING.
O>
NO.OF STORIES BASEMENT Y OR N HIS PE T BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT MMEN WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SQ.FT. HECK ONE A NDON OR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE A CHED
SEASONAL SHORELINE DET H E D
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE TS OF TVONTRAC I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE ON CWASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THA L WWORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
WNE DATEX BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YEAPPROVED1O BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
{11 BY CASH CK MO TOTAL
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Ecx 186 SHELTON, WASHING TON 98584
477-9r;n
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Indicate Pr ne'IS S.
O E=_s2rents and roads
O Septic, drainfield and reserve area. or sewer.
_ O I Septic tank and drainfield setdack distances iron foundations.
O Location of proposed construction an property.
0 Or Building $ septic system sett7ack distances front all property lines easements.
O Well and water line.
Indicate North 0 Saltwater, lakes, rivers, streams, wetlands, drainage.
In Circle O A`ach copy of septa sy4tem"as buiI.- or septic permit approval.
Indicate topography profile of property and structure on reverse side.
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