HomeMy WebLinkAboutBLD30176 Retaining Wall - BLD Application - 4/1/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 Q
427-9670 DATE ISSUED 22 /�]
PERMIT NO. Jc I l
OWNER AIL ADDRESS dSTATE ONE
DIRECTIONS 2)
TO JOB SITE
PARCEL LEGAL
NUMBER �3'p0 DD DESCR.
CONTRACTOR
E M L ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
�,
USE OF
BUILDING
CLASS OF WORK r NEW ADDITION ALTERATION it REPAIR MOVE REMOVE
DESCRIBE
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ 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.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED O DETACHED a
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 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 THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. ^ APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER S *bUDATE �� 11 BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO ��� V
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT t)
D.O.T. BUILDING PLAN CHECK 7
SPECIAL CONDITIONS BUILDING GROUP fv\ PRE INSPECTION
erJX c�j pa e q 1 SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE U
APPLICATION ACCEPTED BY [ZNSCHECKBY APPROVED FOR ISSUANCE PERMIT VALIDATION
L/ TOTAL '
BY 1 ' I 10� CASH CK MO �-7
- I
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670
DATE ISSUED
PERMIT NO,
NA 1E OWNER iAILACORESS CI ATE PHONE
ZIP�
DIRECTIONS
Alf 6:Jf
' TO JOB SITE
PARCEL LEGAL
NUMBER DESCP-
Indicate belovr. O Property lines and dimensions.
O Easements and roads.
O Septic, drainfieid and reserve area, or sewer. THESE PLANS MUST BE
O Septic tank and drainfieid setback distances from founiMoTHE JOB SIME
O Location of proposed construction on property.
O Building8 septics stem setback distances from all rc 1 �-Eit�'
y P l e & easements.
Indicate North O Well and water line.
In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage.
O Attach copy of septic system "as built" or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
A
M 0 a ILD �
v
I
;Z
I �
I I ilil
V"'e cer.,ty that the proposed construction wdl conform to the dim.ens,ons and uses she»n above and that no chanSes will be made without first actaining,approval,
-77
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