HomeMy WebLinkAboutPier - BLD Application - 3/15/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER L,�1rc�R�N � l� �' /-'C.CDi'�Y'� jN�e��' KfLG�i'? � i'V
DIRECTIONS
TO JOB SITE 4' /e'WPARCEL L L-
NUMBER ESCR iC1�i/dam I-e2 J
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING 14;Z A7>pw
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ y /� p� �0 1i /►DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING,
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED,
PERMANENT SHORELINE
SEASONAL
OWNERSAFFIDAVIT 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 M THE BUILDING DE.P RT ENT. APPROVAL FROM THE BUILDING DEPARTMENT.
O
/ n
X W APPROVAL `� y�/ATE X BY DATE
I
FOR OFFICE USE ONLY
DEPARTMENT YES No
O DEPARTMENT YES NO
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
\ STATE BUILDING FEE
STATE SURCHARGE
�PLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
kL TOTAL
BY CASH CK MO