HomeMy WebLinkAboutBLD29851 Retaining Wall - BLD Application - 1/27/1992f �
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED Z
PERMIT NO. v
NAME MAIL ADDRESS CITY d STATE ZIP PHONE
OWNER =e�o S_ 4Z
S-_
DIRECTIONS
TO JOB SITE d .( /STi4 S /S,/7 O>'V N�'�d` 4a A1 17
PARCEL LEGAL
NUMBER DESCR. f
NAME MAIL AD RESS CITY 8 STATE ZIP PHONE LICENSE NO.
CONTRACTOR � ..�o�„'nl � �» � 27S=SfbS
USE OF
BUILDING r NL,�
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE 0 CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
3` COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS �SgFt BATHROOMS SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED❑
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.
4,ee u-
X OWNER DATE X BY DATE_ _
FOR OFFICE USE ONLY
DEPARTMENT VEAPPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
v
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
S ECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
1 0 ^� t SHORELINE
WOODSTOVE
PLUMBING
5 MECHANICAL
STATE BUILDING FEE 1510
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO �LUV