HomeMy WebLinkAboutBLD28950 Pier, Ramp and Float - BLD Application - 9/3/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED! ``
PERMIT NO. ffl761 XJ
OWNERS NAME MAILADDRESS CITY&STATE ZIP PHONE
G-Y-r,- me'.reY 4
1. v ,J CIoveds Slt��c (,l,I�- C / 6 _7L-7
DIRECTIONS /
TO JOB SITE f� vo�c ill;lG 1�'•�' !� /Olo. ��4��- /G1lrr�.NON�� l�rt�
PARCEL + 322.1 S- LEGAL
NUMBER Z 3 S 2oI oo 'Z DESCR. /11lr�i``rvuK7� �(JC� cp Z .3
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING 4i �v1vo/ �` Qc(p5s d
CLASS OF WORK NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE f7l
WORK ..5>`►71(c Per f^asy
BEDROOMS DECKS YOR N CARPORT NOTICE
TOTAL SO.FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. TOTAL SO.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE ATTACHED
SEASONAL SHORELINE 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.
R DATE 7'/ X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVE NO DEPARTMENT YES NO
BUILDING VALUATION
HEALTH N PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
_ SHORELINE
WOODSTOVE
PLUMBING
p j
MECHANICAL llaa
STATE BUILDING FEE
STATESURCHARGE '
APPLICATION ACCEPTED BY P HECK BY�j A OV OR I S PERMIT VALIDATION
��f '� 'fir/ CASH CK MO TOTAL ,5g
MASON COUNTY
DEPARTMENT of GENERAL SERVICES DAM REC'D: Do-
Mason Z
County Sidg.III 426 W. Cedar
P.O. Box 186 Sheiton, Washington 98584
(206) 427-9670
COMPLAINT INVESTIGATION REPORT
_L.tattse or Ccapl aint: ELVI r .c_ 01, —
Location: ZZ2�5 Sa o l y Qa �3 s-ZZ-3 /��r,.�o r�I
Co®laint: -
Address:
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CCr� INVESTIGATED BY: DAM: $� 029 �'0 Y 3
A=0N TAKM: 144 ll� I" /a—OW
Q. VT.A IlVr A=CN HANDLED BY: e DATE: �j