HomeMy WebLinkAboutBLD29766 Pumphouse - BLD Application - 12/26/1991 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.
NAME
N tWl I � Cor:L/t�CTV MAILi� OSV� J 0 PI. CITY&STATE`i"►V� wr>� E--�ACi �
OWNER
DIRECTIONS
TO JOB SITE EI°J►3 FtIL. Y2-L?A-V (vO'tT-f+ TO "!SvNSS-r- �1D(r��t SrV-►ti
`V-u t?✓iV I?l(Ytv t rtvN o M AV -0 UJ ELF fif0 J S�-- -s
PARCEL LEGAL
NUMBER yv 11 -7s'90/Uv DESCR. TP T fttz T PLAT yp 1 "7
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE LICENSE NO.
CONTRACTOR (�� �� LO*jLA ,) Sic /t-0024SS
USE OF ,
BUILDING PU(Y\ P L)
CLASS OF NEW rr JADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK ✓/V(J / x /6 r"t- Y i3j I/) L-i0 tv 4- 7-0 f tv l/S
AREA: � -•f NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES I SHORELINE O CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED❑DETACHED D
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 PER IT IS SSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. C NGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM HE B IL I DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
e
X OWNER �'I` Gam_ DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
HEALTH t PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT 5g
D.O.T. BUILDING \ PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP M PRE-INSPECTION
SHORELINE
c WOODSTOVE
till PLUMBING
MECHANICAL
OR EXCEED LOCAL CODES. IF ANY r STATE BUILDING FEE
QUE, .I L ,
FFIGE 5EFORE CONSTRUCTIO �ti 'a` ,K� p
APPLICATION ACCEPTED BY PLANS CHECK APPROVED FOR ISSUA E PERMIT VALID I
TOTAL
I ?' < IBY CASH CK MO lY
x
�q Ctip
l �� �Q y• �p� �. A• 00
fit
I If
16 4/1
44
X
r;
t .
4:T.
*f k.
1 i
BUILDING PERMIT PLOT PLAN
MASON 000 ti' - •
0EPAn"i -MENTof GENERAL SERVICES
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O Septic, drzir%Raid and reserve are,cr;e•K_r _1w-WE—
_ O Septic tzrx and drain.ieid sattack. is:znczs Imn fce:ndatccns. t
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indicate Nor'.`t 4Z Well znd wz._r Gnu _ JJ
O Sal►Wc:_r, lakes,rivers, s:Ieams,wedznds,dnz:na,� N1�
--- In Circle_ -- O A�,ac;�cac of septic Y ---
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