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HomeMy WebLinkAboutBLD24604 ReRoof - BLD Application - 10/18/1989 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES ,i/ P.O. BOX 186 SHELTON, WASHINGTON 98584 '. - `)7C6 o5r� f/-1'2'fa 427-9670 _ 5�?WA DATE ISSU"EDP ,// -t00 '/ <C_, PERMIT Nc71�'�Y 5� OWNER SAME MAIL ADDRESS CITY4 STATE ZIP PHONE DIRECTIONS A _a TO JOB SITE �0 U � ©Aj PARCEL LEGAL NUMBER aa3 l�� DESCR. 3 CONTRACTOR ( M / MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE USE OF ( _3 BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR WORK r MOVE REMOVE DESCRIBE WORK - �= BEDROOMS DECKS CARPORT NOTICE BATHROOMS TOTAL SQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT TOTAL SQ.FT. FIREPLACE COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL OWNERS FIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRA ON LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIRE ENTS 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 CON RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAIN G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. O NER DATE X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED YES No YES No BUILDING VALUATION HEALTH PUBLIC WORKS PLANNI FEE PING FIRE BUILDING PERMIT ).O.T. BUILDING PLAN CHECK iPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE IATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION BY CASH CK MO TOTAL GARY YANDO,DIRECTOR �pN.STA MO N DEPARTMENT OF COMMUNITY DEVELOPMENT U o T 2 PLANNING -SOLID WASTE -UTILITIES N Y y BLDG. I • 411 N. 5T"ST. • P.O. BOX 578 1864 SHELTON,WA 98584 • (360) 427-9670 DISCLAIIIIER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order, the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting actions'),which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the C-ouacy'b doveiupmt[at i fight iwioi`i-,ike the Count''-p-,r i--in g=!-=s .� �. a > Date (Parcel or Legal Description) Pr perry wner's signature tarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL) STATE OF COUNTY OF On this VL day of (—t , in the year jU),before me L,)21,w YqA,,-r'4 Notary Public, personally appeared 1i!�1 Lk/orsonally known tome to be the person whose name is subscribed to this instrument,and acknowledged that he/she executed it. WITNESS my hand and official seal. -For County use only- Reviewed by applicant on (Date) Notary's si re My Commission Expires: 1 J—- v J Staff Initial: tiiGy:.IL:d U TRAN,SPCJ T AN D f IAN�gs�D r � UIS 76 � Q, `� 226U O, 22� oR �4TFref��s _ O � 2o2o 5 I, Ss , p2 F = 7,8� , 0 67 p, 2mz0S lr Vs,F-